Provider Demographics
NPI:1093003329
Name:HALL, RYAN DAVID (OTR/L)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:DAVID
Last Name:HALL
Suffix:
Gender:M
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4115 OLD CHISMVILLE RD
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:AR
Mailing Address - Zip Code:72936-6927
Mailing Address - Country:US
Mailing Address - Phone:405-464-3660
Mailing Address - Fax:
Practice Address - Street 1:2446 NW 1ST ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73107-6926
Practice Address - Country:US
Practice Address - Phone:405-464-3660
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-20
Last Update Date:2021-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1715225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist