Provider Demographics
NPI:1417799594
Name:HAMMAN, RENEA ILENE
Entity type:Individual
Prefix:
First Name:RENEA
Middle Name:ILENE
Last Name:HAMMAN
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 1:902 POWERS ST
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:IN
Mailing Address - Zip Code:46774-1216
Mailing Address - Country:US
Mailing Address - Phone:260-235-0888
Mailing Address - Fax:
Practice Address - Street 1:520 W LIBERTY ST
Practice Address - Street 2:
Practice Address - City:BUTLER
Practice Address - State:IN
Practice Address - Zip Code:46721-1063
Practice Address - Country:US
Practice Address - Phone:260-868-2164
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-10
Last Update Date:2024-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN31003788A225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist