Provider Demographics
NPI:1679819130
Name:HALL, KATHERINE RENEE
Entity Type:Individual
Prefix:MRS
First Name:KATHERINE
Middle Name:RENEE
Last Name:HALL
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:KATHERINE
Other - Middle Name:RENEE
Other - Last Name:MARKLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7774 NAVARRE PKWY
Mailing Address - Street 2:APT #1224
Mailing Address - City:NAVARRE
Mailing Address - State:FL
Mailing Address - Zip Code:32566-5525
Mailing Address - Country:US
Mailing Address - Phone:860-884-3312
Mailing Address - Fax:
Practice Address - Street 1:2708 NE 14TH ST
Practice Address - Street 2:SUITE 5
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33062-3565
Practice Address - Country:US
Practice Address - Phone:888-880-9279
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-02
Last Update Date:2013-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist