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NPI Code Detail

MEDICARE: JACOB HATHCOCK

MEDICARE: JACOB HATHCOCK
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
1106S00000XBehavior Technician

General Provider Information

NPI Number : 1982553483
Entity Type Code : Individual
Provider Name (Legal Business Name) : JACOB HATHCOCK
Provider Business Mailing Address
First Line : 6766 WILTON DR
Second Line :
City : FORT WORTH
State : TX
Zip : 76133-5145
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 209 BILLINGS ST STE 410
Second Line :
City : ARLINGTON
State : TX
Zip : 76010-2474
Country : US
Telephone Number : 817-592-5665
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/27/2026
Last Update Date : 01/27/2026

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Directions to “ JACOB HATHCOCK ” Practice Location

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