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General NPI Number Information
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NPI Number | 1922490739
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Entity Type | Organization
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Legal Business Name | MOLLY HAMILTON LMT
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Dates
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Enumeration Date | 03/03/2015
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Last Update Date | 03/03/2015
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Provider Practice Location Address
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Address Line | 9415 SW 125TH AVE APT 2
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City | BEAVERTON
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State | OR
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Zip | 97008-4045
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Country | US
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Telephone | 971-409-4412
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Fax |
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Provider Business Mailing Address
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Address Line | 9415 SW 125TH AVE APT 2
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City | BEAVERTON
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State | OR
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Zip | 97008-4045
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Country | US
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Telephone | 971-409-4412
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MOLLY GROW
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Credential |
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Telephone | 971-409-4412
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302R00000X
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Taxonomy Name | Health Maintenance Organization
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License Number | 14507
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License Number State | OR
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