MEDICARE: CHRISTINE HATHAWAY B.C.B.A.

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	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1508131186
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTINE HATHAWAY B.C.B.A.

Provider Business Mailing Address
First Line	:	1130 TEN ROD RD STE C101
Second Line	:
City	:	NORTH KINGSTOWN
State	:	RI
Zip	:	02852-4127
Country	:	US
Telephone Number	:	401-294-8181
Fax Number	:	401-294-9879

Provider Business Practice Location Address
First Line	:	1130 TEN ROD RD STE C101
Second Line	:
City	:	NORTH KINGSTOWN
State	:	RI
Zip	:	02852-4127
Country	:	US
Telephone Number	:	401-294-8181
Fax Number	:	401-294-9879

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

Provider Enumeration Date	:	03/15/2012
Last Update Date	:	03/15/2012

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