Provider Demographics
NPI:1982225652
Name:MCMULLEN-HAMILTON, STEFANIE (LAT)
Entity Type:Individual
Prefix:MRS
First Name:STEFANIE
Middle Name:
Last Name:MCMULLEN-HAMILTON
Suffix:
Gender:F
Credentials:LAT
Other - Prefix:
Other - First Name:STEFANIE
Other - Middle Name:
Other - Last Name:MCMULLEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LAT
Mailing Address - Street 1:10859 FM 2138 N
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75766-8835
Mailing Address - Country:US
Mailing Address - Phone:903-372-9318
Mailing Address - Fax:
Practice Address - Street 1:927 ARP DR
Practice Address - Street 2:
Practice Address - City:TROUP
Practice Address - State:TX
Practice Address - Zip Code:75789-2907
Practice Address - Country:US
Practice Address - Phone:903-842-4618
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-04
Last Update Date:2020-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAT25002255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer