Basic Information
| Provider Information | |||||||||
| NPI: | 1013164045 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HAMILTON | ||||||||
| FirstName: | DARYLL | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | OT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 60 PHILLIPS BRANCH RD | ||||||||
| Address2: | |||||||||
| City: | PHELPS | ||||||||
| State: | KY | ||||||||
| PostalCode: | 415539061 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6064568725 | ||||||||
| FaxNumber: | 6064564938 | ||||||||
| Practice Location | |||||||||
| Address1: | 60 PHILLIPS BRANCH RD | ||||||||
| Address2: | |||||||||
| City: | PHELPS | ||||||||
| State: | KY | ||||||||
| PostalCode: | 415539061 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6064568725 | ||||||||
| FaxNumber: | 6064564938 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/21/2008 | ||||||||
| LastUpdateDate: | 08/21/2008 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | R2281 | KY | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
No ID Information.