Provider Demographics
NPI:1588046635
Name:HAMILL-BARTH, CASEY ANN (LAT)
Entity type:Individual
Prefix:
First Name:CASEY
Middle Name:ANN
Last Name:HAMILL-BARTH
Suffix:
Gender:F
Credentials:LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2305 SPRINGBROOK N
Mailing Address - Street 2:
Mailing Address - City:WAUKESHA
Mailing Address - State:WI
Mailing Address - Zip Code:53186-1242
Mailing Address - Country:US
Mailing Address - Phone:262-366-2741
Mailing Address - Fax:
Practice Address - Street 1:1190 E PARADISE DR
Practice Address - Street 2:
Practice Address - City:WEST BEND
Practice Address - State:WI
Practice Address - Zip Code:53095-5444
Practice Address - Country:US
Practice Address - Phone:262-306-6319
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-25
Last Update Date:2015-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1626-392255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer