Provider Demographics
NPI:1134893704
Name:HAMILTON, LUCAS CARROLL (OTR/L)
Entity type:Individual
Prefix:
First Name:LUCAS
Middle Name:CARROLL
Last Name:HAMILTON
Suffix:
Gender:M
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32 SOUTH RD
Mailing Address - Street 2:
Mailing Address - City:CHEBEAGUE ISLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04017-3006
Mailing Address - Country:US
Mailing Address - Phone:207-939-2602
Mailing Address - Fax:
Practice Address - Street 1:32 SOUTH RD
Practice Address - Street 2:
Practice Address - City:CHEBEAGUE ISLAND
Practice Address - State:ME
Practice Address - Zip Code:04017-3006
Practice Address - Country:US
Practice Address - Phone:207-939-2602
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-05
Last Update Date:2021-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEOT4132225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist