Provider Demographics
NPI:1609161520
Name:HAMEL, JON M (CERTIFIED ORTHOTIST)
Entity Type:Individual
Prefix:MR
First Name:JON
Middle Name:M
Last Name:HAMEL
Suffix:
Gender:M
Credentials:CERTIFIED ORTHOTIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 CHRISTY LN
Mailing Address - Street 2:
Mailing Address - City:RANDOLPH
Mailing Address - State:MA
Mailing Address - Zip Code:02368-1704
Mailing Address - Country:US
Mailing Address - Phone:781-767-6265
Mailing Address - Fax:
Practice Address - Street 1:25 CHRISTY LN
Practice Address - Street 2:
Practice Address - City:RANDOLPH
Practice Address - State:MA
Practice Address - Zip Code:02368-1704
Practice Address - Country:US
Practice Address - Phone:781-767-6265
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-20
Last Update Date:2011-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MACO003979174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist