Provider Demographics
NPI:1902039043
Name:HALL, MELODY ANN (COTA)
Entity Type:Individual
Prefix:
First Name:MELODY
Middle Name:ANN
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 1:155 SAN FELIPE RD
Mailing Address - Street 2:
Mailing Address - City:HOT SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:71909-9726
Mailing Address - Country:US
Mailing Address - Phone:501-844-0453
Mailing Address - Fax:
Practice Address - Street 1:100 GREENWOOD AVE
Practice Address - Street 2:SUITE D
Practice Address - City:HOT SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:71913-4427
Practice Address - Country:US
Practice Address - Phone:501-625-7800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-24
Last Update Date:2009-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AROT-A569224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR178007721Medicaid