MEDICARE: JESSICA LANE 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	224Z00000X	Occupational Therapy Assistant	057.005307	IL
2	224Z00000X	Occupational Therapy Assistant

General Provider Information

NPI Number	:	1386005890
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA LANE HALL

Provider Business Mailing Address
First Line	:	948 W 31ST PL
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60608-6612
Country	:	US
Telephone Number	:	480-244-2144
Fax Number	:

Provider Business Practice Location Address
First Line	:	6501 S PROMONTORY DR # 1003
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60649-1002
Country	:	US
Telephone Number	:	773-256-5788
Fax Number	:

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

Provider Enumeration Date	:	03/10/2016
Last Update Date	:	02/20/2026

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Directions to “ JESSICA LANE HALL ” Practice Location

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