Provider Demographics
NPI:1548385420
Name:HALL, DEBRA DENNINGTON (OCCUPATIONAL THERAPI)
Entity Type:Individual
Prefix:MRS
First Name:DEBRA
Middle Name:DENNINGTON
Last Name:HALL
Suffix:
Gender:F
Credentials:OCCUPATIONAL THERAPI
Other - Prefix:MRS
Other - First Name:DEBBIE
Other - Middle Name:
Other - Last Name:HALL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LOTR
Mailing Address - Street 1:463 ASHLEY RIDGE BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71106-7231
Mailing Address - Country:US
Mailing Address - Phone:318-671-8772
Mailing Address - Fax:318-671-8776
Practice Address - Street 1:463 ASHLEY RIDGE BLVD STE 100
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71106-7231
Practice Address - Country:US
Practice Address - Phone:318-671-8772
Practice Address - Fax:318-671-8776
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAZ11138225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LAZ11138OtherSTATE LICENSE