Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0019X | Occupational Therapist - Physical Rehabilitation | 211335 | TX |
NPI | 1386131621 |
---|---|
Provider Name | Kerlena Hall |
First Address | Dallas, TX 75287-7032 |
Second Address | Dallas, TX 75243-4198 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/04/2018 |
Last Update Date | 20/04/2018 |