MEDICARE: NICOLE HALL

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	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1346787702
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICOLE HALL

Provider Business Mailing Address
First Line	:	7135 SHANNON BLVD
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33908-4218
Country	:	US
Telephone Number	:	812-719-6282
Fax Number	:	239-596-2210

Provider Business Practice Location Address
First Line	:	7135 SHANNON BLVD
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33908-4218
Country	:	US
Telephone Number	:	812-719-6282
Fax Number	:	239-596-2210

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

Provider Enumeration Date	:	01/24/2017
Last Update Date	:	01/24/2017

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Directions to “ NICOLE HALL ” Practice Location

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