Individual
CHAILLE LEEANN HATHAWAY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CTRS
Contact information
Practice address
1490 E BELTLINE AVE SE, GRAND RAPIDS, MI 49506-4336
(616) 940-0040
Mailing address
1490 E BELTLINE AVE SE, GRAND RAPIDS, MI 49506-4336
(616) 940-0040
Taxonomy
Speciality
Code
Description
License number
State
225800000X
Recreation Therapist
Primary
—
MI
Other
Enumeration date
08/15/2012
Last updated
08/15/2012
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