Provider Demographics
NPI:1982656435
Name:HALL, TIMOTHY LEE (OT)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:LEE
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 1:8002 UPTON RD
Mailing Address - Street 2:
Mailing Address - City:LAINGSBURG
Mailing Address - State:MI
Mailing Address - Zip Code:48848-9782
Mailing Address - Country:US
Mailing Address - Phone:517-282-9240
Mailing Address - Fax:
Practice Address - Street 1:9480 E M 21
Practice Address - Street 2:OVID HEALTHCARE CENTER
Practice Address - City:OVID
Practice Address - State:MI
Practice Address - Zip Code:48866-9569
Practice Address - Country:US
Practice Address - Phone:989-834-2228
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-16
Last Update Date:2012-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5201003190225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist