Provider Demographics
NPI:1336444751
Name:HAMM, AMANDA LEBLANC (MS, OTRL)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:LEBLANC
Last Name:HAMM
Suffix:
Gender:F
Credentials:MS, OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:81 ELM ST
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MA
Mailing Address - Zip Code:02021-1223
Mailing Address - Country:US
Mailing Address - Phone:908-456-1326
Mailing Address - Fax:
Practice Address - Street 1:81 ELM ST
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:MA
Practice Address - Zip Code:02021-1223
Practice Address - Country:US
Practice Address - Phone:908-456-1326
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-01-15
Last Update Date:2011-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO3070225X00000X
MA9585225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist