Provider Demographics
NPI:1356745889
Name:HAMM, ROCHELLE MARIE
Entity type:Individual
Prefix:
First Name:ROCHELLE
Middle Name:MARIE
Last Name:HAMM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2301 S PROVIDENCE RD
Mailing Address - Street 2:APT D
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65203-3538
Mailing Address - Country:US
Mailing Address - Phone:507-272-1200
Mailing Address - Fax:
Practice Address - Street 1:1001 ROGERS ST
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65216-1000
Practice Address - Country:US
Practice Address - Phone:573-875-7674
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-13
Last Update Date:2014-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20090296732255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer