Provider Demographics
NPI:1720213614
Name:HALL, CONSTANCE LA'SHAY (COTA)
Entity Type:Individual
Prefix:
First Name:CONSTANCE
Middle Name:LA'SHAY
Last Name:HALL
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5220 HIGHLAND RD
Mailing Address - Street 2:APT #32
Mailing Address - City:RICHWOOD
Mailing Address - State:LA
Mailing Address - Zip Code:71202-3096
Mailing Address - Country:US
Mailing Address - Phone:318-791-1876
Mailing Address - Fax:
Practice Address - Street 1:912 SOUTH PECAN ST
Practice Address - Street 2:VIVIAN HEALTHCARE CENTER
Practice Address - City:VIVIAN
Practice Address - State:LA
Practice Address - Zip Code:71082
Practice Address - Country:US
Practice Address - Phone:318-375-5859
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-20
Last Update Date:2009-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAOTA.200098224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant