Provider Demographics
NPI:1013375393
Name:HALL, LEAH JEAN (MS, OTR/L)
Entity Type:Individual
Prefix:
First Name:LEAH
Middle Name:JEAN
Last Name:HALL
Suffix:
Gender:F
Credentials:MS, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3833 ATTUCKS DR
Mailing Address - Street 2:
Mailing Address - City:POWELL
Mailing Address - State:OH
Mailing Address - Zip Code:43065-6082
Mailing Address - Country:US
Mailing Address - Phone:614-693-8720
Mailing Address - Fax:
Practice Address - Street 1:3833 ATTUCKS DR
Practice Address - Street 2:
Practice Address - City:POWELL
Practice Address - State:OH
Practice Address - Zip Code:43065-6082
Practice Address - Country:US
Practice Address - Phone:614-693-8720
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-02
Last Update Date:2016-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH004345174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH004345OtherOHIO OCCUPATIONAL THERAPY LICENSE