MEDICARE: DAIMIAN HATCH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor
2	171M00000X	Case Manager/Care Coordinator	QMHS	OH

General Provider Information

NPI Number	:	1033835764
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAIMIAN HATCH

Provider Business Mailing Address
First Line	:	2345 DOOR STREET
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43607
Country	:	US
Telephone Number	:	419-407-5342
Fax Number	:

Provider Business Practice Location Address
First Line	:	2345 DOOR STREET
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43607-4360
Country	:	US
Telephone Number	:	419-407-5342
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/14/2022
Last Update Date	:	11/15/2024

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Directions to “ DAIMIAN HATCH ” Practice Location

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