Provider Demographics
NPI:1316373574
Name:HAMILTON, KATELYNN ANNE (MSED)
Entity type:Individual
Prefix:
First Name:KATELYNN
Middle Name:ANNE
Last Name:HAMILTON
Suffix:
Gender:F
Credentials:MSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:632 NEW LOUDON RD
Mailing Address - Street 2:
Mailing Address - City:LATHAM
Mailing Address - State:NY
Mailing Address - Zip Code:12110-4019
Mailing Address - Country:US
Mailing Address - Phone:518-653-9116
Mailing Address - Fax:
Practice Address - Street 1:632 NEW LOUDON RD
Practice Address - Street 2:
Practice Address - City:LATHAM
Practice Address - State:NY
Practice Address - Zip Code:12110-4019
Practice Address - Country:US
Practice Address - Phone:518-653-9116
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-19
Last Update Date:2013-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist