MEDICARE: DANA 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
2	225400000X	Rehabilitation Practitioner

General Provider Information

NPI Number	:	1548589518
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANA HALL

Provider Business Mailing Address
First Line	:	3241 DRAGON FLY ST
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89032-3496
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3241 DRAGON FLY ST
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89032-3496
Country	:	US
Telephone Number	:	702-432-6153
Fax Number	:

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

Provider Enumeration Date	:	05/28/2010
Last Update Date	:	05/27/2011

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Directions to “ DANA HALL ” Practice Location

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