Provider Demographics
NPI:1285210328
Name:HALL, JENNA BETH (OTR/L, DOT)
Entity Type:Individual
Prefix:
First Name:JENNA
Middle Name:BETH
Last Name:HALL
Suffix:
Gender:F
Credentials:OTR/L, DOT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1562 MONTEREY VALLEY PKWY
Mailing Address - Street 2:
Mailing Address - City:SEVERANCE
Mailing Address - State:CO
Mailing Address - Zip Code:80550-3278
Mailing Address - Country:US
Mailing Address - Phone:970-581-3030
Mailing Address - Fax:
Practice Address - Street 1:1562 MONTEREY VALLEY PKWY
Practice Address - Street 2:
Practice Address - City:SEVERANCE
Practice Address - State:CO
Practice Address - Zip Code:80550-3278
Practice Address - Country:US
Practice Address - Phone:970-581-3030
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-19
Last Update Date:2021-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COOT.0005516225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist