Provider Demographics
NPI:1861064438
Name:HAMILTON, MACHELLE
Entity type:Individual
Prefix:
First Name:MACHELLE
Middle Name:
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 1:15676 W 100 S
Mailing Address - Street 2:
Mailing Address - City:MEDARYVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47957-8142
Mailing Address - Country:US
Mailing Address - Phone:121-995-4005
Mailing Address - Fax:
Practice Address - Street 1:1420 SAINT MARYS CIR
Practice Address - Street 2:
Practice Address - City:HOBART
Practice Address - State:IN
Practice Address - Zip Code:46342-6561
Practice Address - Country:US
Practice Address - Phone:219-400-5020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-13
Last Update Date:2021-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05007586A208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
1801891890OtherHTS OUTPATIENT THERAPY