Provider Demographics
NPI:1689034688
Name:HAMM, SPENCER RYAN (LAT, ATC)
Entity Type:Individual
Prefix:MR
First Name:SPENCER
Middle Name:RYAN
Last Name:HAMM
Suffix:
Gender:M
Credentials:LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1101 S. LAKE PARK BLVD.
Mailing Address - Street 2:C15
Mailing Address - City:CAROLINA BEACH
Mailing Address - State:NC
Mailing Address - Zip Code:28428-5638
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6019 OLEANDER DR
Practice Address - Street 2:SUITE 101
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-4796
Practice Address - Country:US
Practice Address - Phone:910-791-0001
Practice Address - Fax:910-791-6888
Is Sole Proprietor?:No
Enumeration Date:2016-03-03
Last Update Date:2016-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC27392255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer