Provider Demographics
NPI:1316203516
Name:HAMM, ANGELA LEA LEA (LMT)
Entity type:Individual
Prefix:
First Name:ANGELA LEA
Middle Name:LEA
Last Name:HAMM
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35350 CHESTER RD
Mailing Address - Street 2:
Mailing Address - City:AVON
Mailing Address - State:OH
Mailing Address - Zip Code:44011-1255
Mailing Address - Country:US
Mailing Address - Phone:330-348-1731
Mailing Address - Fax:
Practice Address - Street 1:35350 CHESTER RD
Practice Address - Street 2:
Practice Address - City:AVON
Practice Address - State:OH
Practice Address - Zip Code:44011-1255
Practice Address - Country:US
Practice Address - Phone:330-348-1731
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-02
Last Update Date:2024-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH33.016217171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor