Provider Demographics
NPI:1093489965
Name:HALL, JACQUELINE MARIE (COTA/L)
Entity Type:Individual
Prefix:MISS
First Name:JACQUELINE
Middle Name:MARIE
Last Name:HALL
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6116 KIRKWOOD CT
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40229-2906
Mailing Address - Country:US
Mailing Address - Phone:502-807-9000
Mailing Address - Fax:
Practice Address - Street 1:6116 KIRKWOOD CT
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40229-2906
Practice Address - Country:US
Practice Address - Phone:502-807-9000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-04
Last Update Date:2021-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY272115224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant