Provider Demographics
NPI:1134438542
Name:HAMILTON, MICHELLE THOMAS (LAC, CMT)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:THOMAS
Last Name:HAMILTON
Suffix:
Gender:F
Credentials:LAC, CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:232 CHORRO ST
Mailing Address - Street 2:
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93405-2316
Mailing Address - Country:US
Mailing Address - Phone:805-748-0121
Mailing Address - Fax:
Practice Address - Street 1:232 CHORRO ST
Practice Address - Street 2:
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93405-2316
Practice Address - Country:US
Practice Address - Phone:805-748-0121
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-03
Last Update Date:2010-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13745171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist