=====================================================
General NPI Number Information
=====================================================
NPI Number | 1134843949
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ZOE LYNN HAMILTON
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/27/2022
-----------------------------------------------------
Last Update Date | 09/27/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 150 SOUTHWINDS RD
-----------------------------------------------------
City | FARMINGTON
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 72730
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 539-240-4735
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 22092 PRENTICE RD
-----------------------------------------------------
City | SUMMERS
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 72769
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 479-313-9163
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 106S00000X
-----------------------------------------------------
Taxonomy Name | Behavior Technician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------