Provider Demographics
NPI:1376997106
Name:HAMILTON, LORI LYNN (M ED)
Entity Type:Individual
Prefix:MR
First Name:LORI
Middle Name:LYNN
Last Name:HAMILTON
Suffix:
Gender:F
Credentials:M ED
Other - Prefix:MISS
Other - First Name:LORI
Other - Middle Name:LYNN
Other - Last Name:BOEBERITZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1302 KINGSPATH DR
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48306-3727
Mailing Address - Country:US
Mailing Address - Phone:248-371-3738
Mailing Address - Fax:
Practice Address - Street 1:1302 KINGSPATH DR
Practice Address - Street 2:
Practice Address - City:ROCHESTER HILLS
Practice Address - State:MI
Practice Address - Zip Code:48306-3727
Practice Address - Country:US
Practice Address - Phone:248-371-3738
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-18
Last Update Date:2016-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI247200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other