Provider Demographics
NPI:1568693166
Name:HALL, CHRISTINE DEBRA (OTR)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:DEBRA
Last Name:HALL
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:CHRISTINE
Other - Middle Name:DEBRA
Other - Last Name:LARSEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR
Mailing Address - Street 1:15861 FLUTE WAY
Mailing Address - Street 2:
Mailing Address - City:APPLE VALLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55124-6011
Mailing Address - Country:US
Mailing Address - Phone:952-953-9568
Mailing Address - Fax:
Practice Address - Street 1:8320 CITY CENTRE DR
Practice Address - Street 2:SUITE G.
Practice Address - City:WOODBURY
Practice Address - State:MN
Practice Address - Zip Code:55125-3382
Practice Address - Country:US
Practice Address - Phone:651-738-9888
Practice Address - Fax:651-738-9889
Is Sole Proprietor?:No
Enumeration Date:2009-07-30
Last Update Date:2010-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN255808225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN255808OtherLICENSE NUMBER