Provider Demographics
NPI:1508459546
Name:HALL, ANESHAWN DAVID (MOTR)
Entity Type:Individual
Prefix:
First Name:ANESHAWN
Middle Name:DAVID
Last Name:HALL
Suffix:
Gender:M
Credentials:MOTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:275 NEIGHBORHOOD WAY
Mailing Address - Street 2:
Mailing Address - City:SPANISH SPRINGS
Mailing Address - State:NV
Mailing Address - Zip Code:89441-9303
Mailing Address - Country:US
Mailing Address - Phone:617-796-8272
Mailing Address - Fax:617-762-2982
Practice Address - Street 1:275 NEIGHBORHOOD WAY
Practice Address - Street 2:
Practice Address - City:SPANISH SPRINGS
Practice Address - State:NV
Practice Address - Zip Code:89441-9303
Practice Address - Country:US
Practice Address - Phone:617-796-8272
Practice Address - Fax:617-792-2983
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-19
Last Update Date:2021-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVOT-2193225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty