Healthcare Provider Details

I. General information

NPI: 1053978817
Provider Name (Legal Business Name): MISS MARIAH LYNN HAMILTON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/28/2019
Last Update Date: 05/28/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 HALLORAN LANE
ST. CLAIRSVILLE OH
43950
US

IV. Provider business mailing address

52800 CHERRY RIDGE RD
BEALLSVILLE OH
43716-8000
US

V. Phone/Fax

Practice location:
  • Phone: 740-269-5743
  • Fax:
Mailing address:
  • Phone: 740-213-4271
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: