Healthcare Provider Details

I. General information

NPI: 1659793503
Provider Name (Legal Business Name): KRISTAL LOUISE HAMILTON MOT, OTR/L, COTA/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/13/2014
Last Update Date: 10/23/2025
Certification Date: 10/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

475 WESTERN AVE STE E
CHILLICOTHEE OH
45601-2288
US

IV. Provider business mailing address

475 WESTERN AVE STE E
CHILLICOTHEE OH
45601-2288
US

V. Phone/Fax

Practice location:
  • Phone: 740-702-3120
  • Fax: 740-702-3123
Mailing address:
  • Phone: 740-702-3120
  • Fax: 740-702-3123

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License NumberOTA.02540
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT013528
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: