Provider Demographics
NPI:1164833257
Name:HALL, JASON (OT)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:
Last Name:HALL
Suffix:
Gender:M
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:129 FAIRFIELD CT
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:TX
Mailing Address - Zip Code:78633-4655
Mailing Address - Country:US
Mailing Address - Phone:979-220-6516
Mailing Address - Fax:
Practice Address - Street 1:129 FAIRFIELD CT
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:TX
Practice Address - Zip Code:78633-4655
Practice Address - Country:US
Practice Address - Phone:979-220-6516
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-12
Last Update Date:2014-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX107860225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist