MEDICARE: JENNIFER HALE OTR/L, CHT

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
1	225X00000X	Occupational Therapist	0119003005	VA

General Provider Information

NPI Number	:	1235187709
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER HALE OTR/L, CHT

Provider Business Mailing Address
First Line	:	PO BOX 75868
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21275-5868
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	13350 FRANKLIN FARM RD STE 300
Second Line	:
City	:	HERNDON
State	:	VA
Zip	:	20171-4095
Country	:	US
Telephone Number	:	703-810-5205
Fax Number	:	703-810-5407

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/05/2006
Last Update Date	:	10/26/2020

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