Provider Demographics
NPI:1205242575
Name:KELLY JO HALL
Entity type:Organization
Organization Name:KELLY JO HALL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:JO
Authorized Official - Last Name:HALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:937-707-7263
Mailing Address - Street 1:98 W STATE ST
Mailing Address - Street 2:
Mailing Address - City:MILFORD CENTER
Mailing Address - State:OH
Mailing Address - Zip Code:43045-9008
Mailing Address - Country:US
Mailing Address - Phone:937-707-7263
Mailing Address - Fax:
Practice Address - Street 1:98 W STATE ST
Practice Address - Street 2:
Practice Address - City:MILFORD CENTER
Practice Address - State:OH
Practice Address - Zip Code:43045-9008
Practice Address - Country:US
Practice Address - Phone:937-707-7263
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-08
Last Update Date:2014-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRG498703347C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347C00000XTransportation ServicesPrivate Vehicle