MEDICARE: MRS. ADAH INEZ HALE 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	12945	CA

General Provider Information

NPI Number	:	1255673513
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ADAH INEZ HALE OTR/L

Provider Business Mailing Address
First Line	:	15415 VAN BUREN ST
Second Line	:
City	:	MIDWAY CITY
State	:	CA
Zip	:	92655-1608
Country	:	US
Telephone Number	:	714-728-8752
Fax Number	:

Provider Business Practice Location Address
First Line	:	15415 VAN BUREN ST
Second Line	:
City	:	MIDWAY CITY
State	:	CA
Zip	:	92655-1608
Country	:	US
Telephone Number	:	714-728-8752
Fax Number	:

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

Provider Enumeration Date	:	03/25/2013
Last Update Date	:	03/25/2013

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