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General NPI Number Information
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NPI Number | 1962967182
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Entity Type | Individual
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Provider Name | TAIYAN HAMILTON MMP, LMT
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Gender | Female
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Dates
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Enumeration Date | 02/01/2019
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Last Update Date | 08/23/2023
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Provider Practice Location Address
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Address Line | 4501 S GENERAL BRUCE DR STE 12
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City | TEMPLE
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State | TX
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Zip | 76502-1466
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Country | US
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Telephone | 254-342-0777
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 482
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City | FRIENDSWOOD
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State | TX
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Zip | 77549-0482
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Country | US
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Telephone | 314-413-7645
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | 118830
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License Number State | TX
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