Provider Demographics
NPI:1740659358
Name:HALL, JEANNETTE MARIE (OT)
Entity type:Individual
Prefix:
First Name:JEANNETTE
Middle Name:MARIE
Last Name:HALL
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5455 ROWLEY RD
Mailing Address - Street 2:UNIT 10102
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78240-4819
Mailing Address - Country:US
Mailing Address - Phone:859-661-3685
Mailing Address - Fax:
Practice Address - Street 1:5455 ROWLEY RD
Practice Address - Street 2:UNIT 10102
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78240-4819
Practice Address - Country:US
Practice Address - Phone:859-661-3685
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-24
Last Update Date:2015-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYR3629282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital