Provider Demographics
NPI:1609341544
Name:HALL, HEATHER (OTRL)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:
Last Name:HALL
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 498
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04963-0498
Mailing Address - Country:US
Mailing Address - Phone:207-877-5649
Mailing Address - Fax:207-248-0044
Practice Address - Street 1:290 ROCKY SHORE LN
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:ME
Practice Address - Zip Code:04963-4433
Practice Address - Country:US
Practice Address - Phone:631-626-5541
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-08
Last Update Date:2023-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEOT3533225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist