Provider Demographics
NPI:1225884588
Name:HAMIL, CATHY (LICENSED TATTOO)
Entity type:Individual
Prefix:
First Name:CATHY
Middle Name:
Last Name:HAMIL
Suffix:
Gender:F
Credentials:LICENSED TATTOO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:176 OAKMONT AVE
Mailing Address - Street 2:
Mailing Address - City:LAKE OZARK
Mailing Address - State:MO
Mailing Address - Zip Code:65049-5717
Mailing Address - Country:US
Mailing Address - Phone:260-433-6799
Mailing Address - Fax:
Practice Address - Street 1:985 EXECUTIVE DR
Practice Address - Street 2:
Practice Address - City:OSAGE BEACH
Practice Address - State:MO
Practice Address - Zip Code:65065-3496
Practice Address - Country:US
Practice Address - Phone:573-321-4565
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-27
Last Update Date:2024-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2015034362246Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246Z00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, Other