MEDICARE: MRS. LAVINA F HAMILTON

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
1	1744P3200X	Prosthetics Case Management
2	222Q00000X	Developmental Therapist		IL
3	174400000X	Specialist	011.280802	IL

General Provider Information

NPI Number	:	1932309655
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LAVINA F HAMILTON

Provider Business Mailing Address
First Line	:	9110 S SPAULDING AVE
Second Line	:
City	:	EVERGREEN PARK
State	:	IL
Zip	:	60805-1550
Country	:	US
Telephone Number	:	773-512-7008
Fax Number	:	708-575-1953

Provider Business Practice Location Address
First Line	:	10544 S HARLEM AVE STE 205
Second Line	:
City	:	PALOS HILLS
State	:	IL
Zip	:	60465-2063
Country	:	US
Telephone Number	:	773-242-9408
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/20/2007
Last Update Date	:	03/10/2025

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