MEDICARE: HALL'S BRACE CENT

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	222Z00000X	Orthotist

General Provider Information

NPI Number	:	1336561844
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HALL'S BRACE CENT

Provider Business Mailing Address
First Line	:	2578 N MARTIN LUTHER KING DR
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53212-2710
Country	:	US
Telephone Number	:	414-581-4255
Fax Number	:

Provider Business Practice Location Address
First Line	:	2578 N MARTIN LUTHER KING DR
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53212-2710
Country	:	US
Telephone Number	:	414-581-4255
Fax Number	:

Authorized Official
Title or Position	:	CERTIFIED ORTHOTIST
Name	:	CHARLES HALL
Credential	:	CO
Telephone Number	:	414-581-4255

Provider Enumeration Date	:	01/17/2014
Last Update Date	:	01/17/2014

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