Provider Demographics
NPI:1831576503
Name:HALL, BRITTNE (COTA/L)
Entity type:Individual
Prefix:
First Name:BRITTNE
Middle Name:
Last Name:HALL
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 N OAK ST
Mailing Address - Street 2:
Mailing Address - City:COTTAGE HILLS
Mailing Address - State:IL
Mailing Address - Zip Code:62018-1508
Mailing Address - Country:US
Mailing Address - Phone:618-978-6432
Mailing Address - Fax:
Practice Address - Street 1:401 SAINT MARYS DR
Practice Address - Street 2:
Practice Address - City:EDWARDSVILLE
Practice Address - State:IL
Practice Address - Zip Code:62025-4276
Practice Address - Country:US
Practice Address - Phone:618-692-1330
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-01
Last Update Date:2015-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL057.004240224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant