Provider Demographics
NPI:1609901941
Name:HAMILTON, LIANE MILLER (MS,OTRL)
Entity Type:Individual
Prefix:MRS
First Name:LIANE
Middle Name:MILLER
Last Name:HAMILTON
Suffix:
Gender:F
Credentials:MS,OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5600 SWANSTON DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28269-9141
Mailing Address - Country:US
Mailing Address - Phone:704-560-2170
Mailing Address - Fax:
Practice Address - Street 1:9606 BAILEY RD
Practice Address - Street 2:SUITE 250
Practice Address - City:CORNELIUS
Practice Address - State:NC
Practice Address - Zip Code:28031-6109
Practice Address - Country:US
Practice Address - Phone:704-560-2170
Practice Address - Fax:704-896-7975
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3955225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7301282Medicaid
NC1185VOtherBLUE CROSS BLUE SHIELD