Provider Demographics
NPI:1780018556
Name:HALLUMS, NICOLE RHEANNE (OTA)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:RHEANNE
Last Name:HALLUMS
Suffix:
Gender:F
Credentials:OTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8103 NORTH HOLW
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78240-2387
Mailing Address - Country:US
Mailing Address - Phone:210-558-9001
Mailing Address - Fax:210-558-9010
Practice Address - Street 1:8103 NORTH HOLW
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78240-2387
Practice Address - Country:US
Practice Address - Phone:210-558-9001
Practice Address - Fax:210-558-9010
Is Sole Proprietor?:No
Enumeration Date:2013-08-28
Last Update Date:2013-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX209942224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant