MEDICARE: STEPHANIE NICOLE HALL M.S., 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
1	225X00000X	Occupational Therapist	63-015621	NY
2	225X00000X	Occupational Therapist	7279	NC

General Provider Information

NPI Number	:	1457591497
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHANIE NICOLE HALL M.S., OTR/L

Provider Business Mailing Address
First Line	:	2427 MEDWAY DR
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27608-1612
Country	:	US
Telephone Number	:	919-539-7665
Fax Number	:

Provider Business Practice Location Address
First Line	:	2427 MEDWAY DR
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27608-1612
Country	:	US
Telephone Number	:	919-539-7665
Fax Number	:

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

Provider Enumeration Date	:	03/04/2009
Last Update Date	:	08/18/2015

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