MEDICARE: RICK HALE

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	224Z00000X	Occupational Therapy Assistant	211053	TX

General Provider Information

NPI Number	:	1255626446
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RICK HALE

Provider Business Mailing Address
First Line	:	4109 HIGHWAY 98 W
Second Line	:
City	:	SUMMIT
State	:	MS
Zip	:	39666-9132
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1884 LOOP 343 WEST
Second Line	:
City	:	RUSK
State	:	TX
Zip	:	75785
Country	:	US
Telephone Number	:	903-683-1042
Fax Number	:

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

Provider Enumeration Date	:	06/15/2011
Last Update Date	:	06/15/2011

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Directions to “ RICK HALE ” Practice Location

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