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NPI Code Detail

MEDICARE: STACEY M HALL

MEDICARE: STACEY M HALL
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225XP0200XPediatric Occupational Therapist174700KY
2225X00000XOccupational Therapist174700KY

General Provider Information

NPI Number : 1154834463
Entity Type Code : Individual
Provider Name (Legal Business Name) : STACEY M HALL
Provider Business Mailing Address
First Line : 90 HOWARD DR
Second Line :
City : SHELBYVILLE
State : KY
Zip : 40065-8138
Country : US
Telephone Number : 502-633-1007
Fax Number :
Provider Business Practice Location Address
First Line : 11840 COMMONWEALTH DR
Second Line :
City : LOUISVILLE
State : KY
Zip : 40299-2309
Country : US
Telephone Number : 502-633-1007
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/08/2017
Last Update Date : 12/12/2022

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Directions to “ STACEY M HALL ” Practice Location

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