Healthcare Provider Details

I. General information

NPI: 1073668760
Provider Name (Legal Business Name): TERESA J HALL OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/24/2007
Last Update Date: 04/19/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12772 HAMILTON CROSSING BLVD
CARMEL IN
46032-5422
US

IV. Provider business mailing address

201 PENNSYLVANIA PKWY STE 200
INDIANAPOLIS IN
46280-1393
US

V. Phone/Fax

Practice location:
  • Phone: 317-814-1000
  • Fax: 317-814-1015
Mailing address:
  • Phone: 317-805-5500
  • Fax: 317-805-5501

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number31000750A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: