Healthcare Provider Details

I. General information

NPI: 1194093245
Provider Name (Legal Business Name): KIM ANNE HALL M.S., OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/05/2011
Last Update Date: 11/30/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

136 CHLORINATOR RD
MILFORD NY
13807-1130
US

IV. Provider business mailing address

136 CHLORINATOR RD
MILFORD NY
13807-1130
US

V. Phone/Fax

Practice location:
  • Phone: 315-525-8084
  • Fax:
Mailing address:
  • Phone: 315-525-8084
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number010463-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: