Provider Demographics
NPI:1881066629
Name:HALL, CAROL SAMANTHA (OTR/L)
Entity type:Individual
Prefix:MRS
First Name:CAROL
Middle Name:SAMANTHA
Last Name:HALL
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:CAROL
Other - Middle Name:SAMANTHA
Other - Last Name:MITCHELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:2909 CARLETON ST
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92106-2713
Mailing Address - Country:US
Mailing Address - Phone:303-649-9007
Mailing Address - Fax:
Practice Address - Street 1:6535 S DAYTON ST
Practice Address - Street 2:
Practice Address - City:GREENWOOD VILLAGE
Practice Address - State:CO
Practice Address - Zip Code:80111
Practice Address - Country:US
Practice Address - Phone:303-649-9007
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-20
Last Update Date:2019-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COOT.0004418225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist