Healthcare Provider Details

I. General information

NPI: 1922872803
Provider Name (Legal Business Name): HALLIE HOCH OTRL, MOT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/10/2023
Last Update Date: 11/10/2023
Certification Date: 11/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1925 STATE ROAD 207
ST AUGUSTINE FL
32086-9325
US

IV. Provider business mailing address

23211 HARBOUR VISTA CIR
ST AUGUSTINE FL
32080-5124
US

V. Phone/Fax

Practice location:
  • Phone: 904-315-8525
  • Fax:
Mailing address:
  • Phone: 678-527-4886
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number24628
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: