Provider Demographics
NPI:1275171134
Name:HAMLET, BLAYRE MARYLYNN
Entity Type:Individual
Prefix:
First Name:BLAYRE
Middle Name:MARYLYNN
Last Name:HAMLET
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 1:33 ERSKINE LN
Mailing Address - Street 2:
Mailing Address - City:SCOTT DEPOT
Mailing Address - State:WV
Mailing Address - Zip Code:25560-7842
Mailing Address - Country:US
Mailing Address - Phone:681-235-7211
Mailing Address - Fax:681-235-7221
Practice Address - Street 1:33 ERSKINE LN
Practice Address - Street 2:
Practice Address - City:SCOTT DEPOT
Practice Address - State:WV
Practice Address - Zip Code:25560-7842
Practice Address - Country:US
Practice Address - Phone:681-235-7211
Practice Address - Fax:681-235-7221
Is Sole Proprietor?:No
Enumeration Date:2019-12-11
Last Update Date:2021-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X, 3747P1801X
WV106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant