Provider Demographics
NPI:1619113305
Name:HAMM, KATIE LYN (OT)
Entity Type:Individual
Prefix:
First Name:KATIE
Middle Name:LYN
Last Name:HAMM
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2601 NE 14TH AVE APT 113
Mailing Address - Street 2:
Mailing Address - City:OAKLAND PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33334-4379
Mailing Address - Country:US
Mailing Address - Phone:940-367-7436
Mailing Address - Fax:
Practice Address - Street 1:2601 NE 14TH AVE APT 113
Practice Address - Street 2:
Practice Address - City:OAKLAND PARK
Practice Address - State:FL
Practice Address - Zip Code:33334-4379
Practice Address - Country:US
Practice Address - Phone:940-367-7436
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-30
Last Update Date:2010-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX17375403225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics