Provider Demographics
NPI:1982641908
Name:HALL, BRENTLEY W (OT)
Entity Type:Individual
Prefix:MR
First Name:BRENTLEY
Middle Name:W
Last Name:HALL
Suffix:
Gender:M
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3656 GOVERNMENT BLVD STE F
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36693-4305
Mailing Address - Country:US
Mailing Address - Phone:251-300-6666
Mailing Address - Fax:251-300-6665
Practice Address - Street 1:3656 GOVERNMENT BLVD STE F
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36693-4305
Practice Address - Country:US
Practice Address - Phone:251-300-6666
Practice Address - Fax:251-300-6665
Is Sole Proprietor?:No
Enumeration Date:2006-05-31
Last Update Date:2013-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1514225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51533861OtherBCBS OF ALABAMA
AL51533861OtherBCBS OF ALABAMA