Provider Demographics
NPI:1134769623
Name:LITTLE, HALLIE PEARL
Entity type:Individual
Prefix:
First Name:HALLIE
Middle Name:PEARL
Last Name:LITTLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 6TH ST
Mailing Address - Street 2:
Mailing Address - City:FAIRBANK
Mailing Address - State:IA
Mailing Address - Zip Code:50629-8592
Mailing Address - Country:US
Mailing Address - Phone:319-404-5870
Mailing Address - Fax:
Practice Address - Street 1:910 E OLIVE ST
Practice Address - Street 2:
Practice Address - City:MARSHALLTOWN
Practice Address - State:IA
Practice Address - Zip Code:50158-4175
Practice Address - Country:US
Practice Address - Phone:641-752-4581
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-13
Last Update Date:2020-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA097750224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant