Provider Demographics
NPI:1447018627
Name:HATCHER, DEVON (MA61109301)
Entity type:Individual
Prefix:
First Name:DEVON
Middle Name:
Last Name:HATCHER
Suffix:
Gender:M
Credentials:MA61109301
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3706 140TH AVE SE
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98006-1540
Mailing Address - Country:US
Mailing Address - Phone:425-569-9764
Mailing Address - Fax:
Practice Address - Street 1:16701 NE 80TH ST
Practice Address - Street 2:
Practice Address - City:REDMOND
Practice Address - State:WA
Practice Address - Zip Code:98052-3937
Practice Address - Country:US
Practice Address - Phone:425-569-9764
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-12
Last Update Date:2024-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA61109301225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist