MEDICARE: JACQUELYN HALE

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	226300000X	Kinesiotherapist

General Provider Information

NPI Number	:	1407215106
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACQUELYN HALE

Provider Business Mailing Address
First Line	:	6254 WARM SPRINGS RD
Second Line	:	APT E-17
City	:	COLUMBUS
State	:	GA
Zip	:	31909-9133
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	301 WIRE RD
Second Line	:
City	:	AUBURN
State	:	AL
Zip	:	36849-5419
Country	:	US
Telephone Number	:	334-844-1694
Fax Number	:

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

Provider Enumeration Date	:	02/23/2016
Last Update Date	:	02/23/2016

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Directions to “ JACQUELYN HALE ” Practice Location

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