Provider Demographics
NPI:1932309655
Name:HAMILTON, LAVINA F
Entity Type:Individual
Prefix:MRS
First Name:LAVINA
Middle Name:F
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 1:9110 S SPAULDING AVE
Mailing Address - Street 2:
Mailing Address - City:EVERGREEN PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60805-1550
Mailing Address - Country:US
Mailing Address - Phone:773-512-7008
Mailing Address - Fax:708-575-1953
Practice Address - Street 1:9110 S SPAULDING AVE
Practice Address - Street 2:
Practice Address - City:EVERGREEN PARK
Practice Address - State:IL
Practice Address - Zip Code:60805-1550
Practice Address - Country:US
Practice Address - Phone:773-242-9408
Practice Address - Fax:708-575-1953
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-20
Last Update Date:2023-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1744P3200X
IL222Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental TherapistGroup - Multi-Specialty
No1744P3200XOther Service ProvidersSpecialistProsthetics Case ManagementGroup - Multi-Specialty