Provider Demographics
NPI:1013164045
Name:HAMILTON, DARYLL (OT)
Entity type:Individual
Prefix:MR
First Name:DARYLL
Middle Name:
Last Name:HAMILTON
Suffix:
Gender:M
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60 PHILLIPS BRANCH RD
Mailing Address - Street 2:
Mailing Address - City:PHELPS
Mailing Address - State:KY
Mailing Address - Zip Code:41553-9061
Mailing Address - Country:US
Mailing Address - Phone:606-456-8725
Mailing Address - Fax:606-456-4938
Practice Address - Street 1:60 PHILLIPS BRANCH RD
Practice Address - Street 2:
Practice Address - City:PHELPS
Practice Address - State:KY
Practice Address - Zip Code:41553-9061
Practice Address - Country:US
Practice Address - Phone:606-456-8725
Practice Address - Fax:606-456-4938
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-21
Last Update Date:2008-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYR2281225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist