Healthcare Provider Details

I. General information

NPI: 1679824684
Provider Name (Legal Business Name): KRISTIN HAMNER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/01/2012
Last Update Date: 10/01/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

515 2ND AVENUE NW
REFORM AL
35481
US

IV. Provider business mailing address

4109 HIGHWAY 98 W
SUMMIT MS
39666-9132
US

V. Phone/Fax

Practice location:
  • Phone: 205-375-2465
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number2896
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: