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NPI Code Detail

MEDICARE: KRISTEN MICHELLE HALE MOT, OTR/L

MEDICARE: KRISTEN MICHELLE HALE MOT, OTR/L
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
1225X00000XOccupational TherapistOT.0005619CO

General Provider Information

NPI Number : 1265089684
Entity Type Code : Individual
Provider Name (Legal Business Name) : KRISTEN MICHELLE HALE MOT, OTR/L
Provider Business Mailing Address
First Line : 6313 VILLAGE LN
Second Line :
City : COLORADO SPRINGS
State : CO
Zip : 80918-8349
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 12105 AMBASSADOR DR
Second Line :
City : COLORADO SPRINGS
State : CO
Zip : 80921-3642
Country : US
Telephone Number : 719-494-9667
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/20/2019
Last Update Date : 08/20/2019

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