Provider Demographics
NPI:1003037847
Name:HAM, ELEANOR HOLSTON (MS, OTRL)
Entity Type:Individual
Prefix:MS
First Name:ELEANOR
Middle Name:HOLSTON
Last Name:HAM
Suffix:
Gender:F
Credentials:MS, OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 EXECUTIVE EST
Mailing Address - Street 2:
Mailing Address - City:LONDON
Mailing Address - State:KY
Mailing Address - Zip Code:40744-7894
Mailing Address - Country:US
Mailing Address - Phone:606-224-0353
Mailing Address - Fax:
Practice Address - Street 1:740 E LAUREL RD
Practice Address - Street 2:
Practice Address - City:LONDON
Practice Address - State:KY
Practice Address - Zip Code:40741-8601
Practice Address - Country:US
Practice Address - Phone:606-877-3950
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-01
Last Update Date:2023-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY277279225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist