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General NPI Number Information
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NPI Number | 1336019322
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Entity Type | Individual
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Provider Name | BREANNA EILEEN HATCH
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Gender | Female
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Dates
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Enumeration Date | 11/06/2025
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Last Update Date | 11/06/2025
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Provider Practice Location Address
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Address Line | 835 E VINE ST
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City | MURRAY
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State | UT
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Zip | 84107-6515
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Country | US
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Telephone | 801-693-3800
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Fax |
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Provider Business Mailing Address
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Address Line | 175 E 475 N
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City | NORTH SALT LAKE
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State | UT
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Zip | 84054-2338
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Country | US
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Telephone | 425-551-9708
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225800000X
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Taxonomy Name | Recreation Therapist
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License Number | 14252330-4003
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License Number State | UT
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