Healthcare Provider Details

I. General information

NPI: 1760095327
Provider Name (Legal Business Name): TAMARA LEAH HALL THERAPIST
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2020
Last Update Date: 09/21/2026
Certification Date: 09/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 UPPER KANAWHA VALLEY WAY
CABIN CREEK WV
25035
US

IV. Provider business mailing address

258 VIRGINIA ST
OAK HILL WV
25901-2452
US

V. Phone/Fax

Practice location:
  • Phone: 681-463-6719
  • Fax:
Mailing address:
  • Phone: 681-463-6719
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: