Provider Demographics
NPI:1477592749
Name:HALL, RENEE (OCCUPATIONAL THERAPY)
Entity type:Individual
Prefix:
First Name:RENEE
Middle Name:
Last Name:HALL
Suffix:
Gender:F
Credentials:OCCUPATIONAL THERAPY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 40480
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36640-0480
Mailing Address - Country:US
Mailing Address - Phone:251-665-8201
Mailing Address - Fax:251-665-8211
Practice Address - Street 1:1601 CENTER ST
Practice Address - Street 2:STE 3N-C
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36604-1512
Practice Address - Country:US
Practice Address - Phone:251-665-8201
Practice Address - Fax:251-665-8211
Is Sole Proprietor?:No
Enumeration Date:2006-06-05
Last Update Date:2017-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1262225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51533941OtherBCBS
AL890016080Medicaid