Provider Demographics
NPI:1114902020
Name:HALL, KARI SHANKS (MA, OTR)
Entity Type:Individual
Prefix:MRS
First Name:KARI
Middle Name:SHANKS
Last Name:HALL
Suffix:
Gender:F
Credentials:MA, OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7935 E PRENTICE AVE
Mailing Address - Street 2:SUITE 104
Mailing Address - City:GREENWOOD VILLAGE
Mailing Address - State:CO
Mailing Address - Zip Code:80111-2708
Mailing Address - Country:US
Mailing Address - Phone:303-756-0280
Mailing Address - Fax:303-756-6059
Practice Address - Street 1:7935 E PRENTICE AVE
Practice Address - Street 2:SUITE 104
Practice Address - City:GREENWOOD VILLAGE
Practice Address - State:CO
Practice Address - Zip Code:80111-2708
Practice Address - Country:US
Practice Address - Phone:303-756-0280
Practice Address - Fax:303-756-6059
Is Sole Proprietor?:No
Enumeration Date:2005-12-13
Last Update Date:2013-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO600122225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO07026016Medicaid