Provider Demographics
NPI:1912596834
Name:HAMEL, MIKELLE CHEYENNE (MT-BC)
Entity Type:Individual
Prefix:
First Name:MIKELLE
Middle Name:CHEYENNE
Last Name:HAMEL
Suffix:
Gender:F
Credentials:MT-BC
Other - Prefix:MRS
Other - First Name:MIKELLE
Other - Middle Name:CHEYENNE
Other - Last Name:HAGEDORN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MT-BC
Mailing Address - Street 1:4917 S KAREN ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73135-2209
Mailing Address - Country:US
Mailing Address - Phone:405-590-5469
Mailing Address - Fax:
Practice Address - Street 1:4917 S KAREN ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73135-2209
Practice Address - Country:US
Practice Address - Phone:405-590-5469
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-14
Last Update Date:2021-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ15240225A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist