Provider Demographics
NPI:1598024085
Name:HAMILTON, BRITTNEY DOREEN
Entity Type:Individual
Prefix:
First Name:BRITTNEY
Middle Name:DOREEN
Last Name:HAMILTON
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 1:1730 PIONEER ST
Mailing Address - Street 2:
Mailing Address - City:PHILOMATH
Mailing Address - State:OR
Mailing Address - Zip Code:97370-9226
Mailing Address - Country:US
Mailing Address - Phone:541-740-0403
Mailing Address - Fax:541-929-2630
Practice Address - Street 1:1730 PIONEER ST
Practice Address - Street 2:
Practice Address - City:PHILOMATH
Practice Address - State:OR
Practice Address - Zip Code:97370-9226
Practice Address - Country:US
Practice Address - Phone:541-740-0403
Practice Address - Fax:541-929-2630
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-03
Last Update Date:2012-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR18925225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist