MEDICARE: LEAH GRACE HAMILTON

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	2255A2300X	Athletic Trainer

General Provider Information

NPI Number	:	1790526135
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LEAH GRACE HAMILTON

Provider Business Mailing Address
First Line	:	2398 PALAZZO DR
Second Line	:
City	:	BUFFALO GROVE
State	:	IL
Zip	:	60089-4674
Country	:	US
Telephone Number	:	847-521-0884
Fax Number	:

Provider Business Practice Location Address
First Line	:	2398 PALAZZO DR
Second Line	:
City	:	BUFFALO GROVE
State	:	IL
Zip	:	60089-4674
Country	:	US
Telephone Number	:	847-521-0884
Fax Number	:

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

Provider Enumeration Date	:	05/31/2024
Last Update Date	:	07/01/2026

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Directions to “ LEAH GRACE HAMILTON ” Practice Location

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