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General NPI Number Information
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NPI Number | 1982142279
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Entity Type | Individual
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Provider Name | MATTHEW KENNETH HAMILTON TH.D., CFT, SSN,
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Gender | Male
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Dates
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Enumeration Date | 02/07/2017
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Last Update Date | 02/07/2017
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Provider Practice Location Address
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Address Line | 1898 FORT RD BLDG 2 WELLNESS CENTER
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City | SHERIDAN
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State | WY
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Zip | 82801-8320
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Country | US
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Telephone | 307-675-3781
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Fax |
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Provider Business Mailing Address
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Address Line | 1511 MYDLAND RD LOT 171
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City | SHERIDAN
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State | WY
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Zip | 82801-2138
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Country | US
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Telephone | 307-752-9077
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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 | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 226000000X
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Taxonomy Name | Recreational Therapist Assistant
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License Number |
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License Number State |
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