Provider Demographics
NPI:1508091877
Name:HAMILTON, ANTONIUS DEWAYNE (OTR/L)
Entity Type:Individual
Prefix:MR
First Name:ANTONIUS
Middle Name:DEWAYNE
Last Name:HAMILTON
Suffix:
Gender:M
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:217 4TH AVE S
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35205-3231
Mailing Address - Country:US
Mailing Address - Phone:205-368-8116
Mailing Address - Fax:205-553-2673
Practice Address - Street 1:403 34TH AVE E
Practice Address - Street 2:
Practice Address - City:TUSCALOOSA
Practice Address - State:AL
Practice Address - Zip Code:35404-3327
Practice Address - Country:US
Practice Address - Phone:205-368-8116
Practice Address - Fax:205-553-2673
Is Sole Proprietor?:No
Enumeration Date:2009-05-15
Last Update Date:2009-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2996225X00000X
AL1034227800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No227800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, Certified