MEDICARE: DR. JACLYN NICOLE HATCHER DPT

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	225100000X	Physical Therapist	62 030455	NY

General Provider Information

NPI Number	:	1952555641
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JACLYN NICOLE HATCHER DPT

Provider Business Mailing Address
First Line	:	112 MILLTOWN RD
Second Line	:
City	:	HOLMES
State	:	NY
Zip	:	12531-5006
Country	:	US
Telephone Number	:	845-661-4833
Fax Number	:

Provider Business Practice Location Address
First Line	:	470 MAMARONECK AVE STE 204
Second Line	:
City	:	WHITE PLAINS
State	:	NY
Zip	:	10605-1839
Country	:	US
Telephone Number	:	914-421-8270
Fax Number	:

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

Provider Enumeration Date	:	11/09/2008
Last Update Date	:	11/09/2008

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