Provider Demographics
NPI:1548741838
Name:HAMILTON, HOLLY JO
Entity type:Individual
Prefix:
First Name:HOLLY
Middle Name:JO
Last Name:HAMILTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 142
Mailing Address - Street 2:
Mailing Address - City:SIMMS
Mailing Address - State:MT
Mailing Address - Zip Code:59477-0142
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:12854 MONTANA HWY 200
Practice Address - Street 2:
Practice Address - City:SIMMS
Practice Address - State:MT
Practice Address - Zip Code:59477
Practice Address - Country:US
Practice Address - Phone:406-475-2654
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-24
Last Update Date:2018-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT13998225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist