MEDICARE: PAIGE BRIELLE HAMBER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	335E00000X	Prosthetic/Orthotic Supplier

General Provider Information

NPI Number	:	1487301545
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAIGE BRIELLE HAMBER

Provider Business Mailing Address
First Line	:	9150 VICTORY AVE
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63136-1546
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	9150 VICTORY AVE
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63136-1546
Country	:	US
Telephone Number	:	314-202-0626
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/08/2022
Last Update Date	:	03/08/2022

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Directions to “ PAIGE BRIELLE HAMBER ” Practice Location

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