Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225X00000X | Occupational Therapist | ||
N | 225XH1200X | Occupational Therapist - Hand | ||
N | 225XN1300X | Occupational Therapist - Neurorehabilitation | ||
N | 225XP0200X | Occupational Therapist - Pediatrics |
NPI | 1508928136 |
---|---|
Provider Name | Mr. Timothy P Hall |
First Address | Ridgecrest, CA 93555-4708 |
Second Address | Ridgecrest, CA 93555-4708 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/12/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00002628 | LICENSE (01) | WA |
1003611 | NATIONAL NBCOT (01) | |
3988 | OT LICENSE (01) | CA |