Provider Demographics
NPI:1568746568
Name:HALL-ROSENTHAL, DONNA (OT/CHT)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:
Last Name:HALL-ROSENTHAL
Suffix:
Gender:F
Credentials:OT/CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8823 PRODUCTION LN
Mailing Address - Street 2:
Mailing Address - City:OOLTEWAH
Mailing Address - State:TN
Mailing Address - Zip Code:37363-6511
Mailing Address - Country:US
Mailing Address - Phone:423-238-7217
Mailing Address - Fax:423-238-3473
Practice Address - Street 1:4510 NELSON BROGDON BLVD
Practice Address - Street 2:
Practice Address - City:BUFORD
Practice Address - State:GA
Practice Address - Zip Code:30518-3478
Practice Address - Country:US
Practice Address - Phone:770-945-1045
Practice Address - Fax:770-954-5745
Is Sole Proprietor?:No
Enumeration Date:2011-10-10
Last Update Date:2013-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOT000863225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAOT000863OtherGEORGIA OCCUPATIONAL THERAPY LICENSE NUMBER