Provider Demographics
NPI:1730812405
Name:HATHAWAY, CIARA ALEXIS (OTR)
Entity type:Individual
Prefix:MRS
First Name:CIARA
Middle Name:ALEXIS
Last Name:HATHAWAY
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 DIANE DR
Mailing Address - Street 2:
Mailing Address - City:OTEGO
Mailing Address - State:NY
Mailing Address - Zip Code:13825-2167
Mailing Address - Country:US
Mailing Address - Phone:570-301-3123
Mailing Address - Fax:
Practice Address - Street 1:1 TITUS PL
Practice Address - Street 2:
Practice Address - City:WALTON
Practice Address - State:NY
Practice Address - Zip Code:13856-1457
Practice Address - Country:US
Practice Address - Phone:607-865-2155
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-08
Last Update Date:2022-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP115725225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist