Provider Demographics
NPI:1245364561
Name:HAMILTON, CARLA J (OTR-L)
Entity type:Individual
Prefix:
First Name:CARLA
Middle Name:J
Last Name:HAMILTON
Suffix:
Gender:F
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 1:12108 SHADYBROOK DR
Mailing Address - Street 2:
Mailing Address - City:KELLER
Mailing Address - State:TX
Mailing Address - Zip Code:76248-7787
Mailing Address - Country:US
Mailing Address - Phone:817-508-8737
Mailing Address - Fax:817-508-8735
Practice Address - Street 1:4113 GATEWAY DR
Practice Address - Street 2:STE 200
Practice Address - City:COLLEYVILLE
Practice Address - State:TX
Practice Address - Zip Code:76034-5943
Practice Address - Country:US
Practice Address - Phone:817-508-8737
Practice Address - Fax:817-508-8735
Is Sole Proprietor?:No
Enumeration Date:2007-03-16
Last Update Date:2012-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX110953225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8T7249OtherBCBS
TX8F6995Medicare PIN