Provider Demographics
NPI:1881159911
Name:HALL, DARLENE (COTA/L)
Entity type:Individual
Prefix:
First Name:DARLENE
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 1:208 GREEN PINE WAY
Mailing Address - Street 2:
Mailing Address - City:EASLEY
Mailing Address - State:SC
Mailing Address - Zip Code:29642-9191
Mailing Address - Country:US
Mailing Address - Phone:864-421-5177
Mailing Address - Fax:
Practice Address - Street 1:205 BUD NALLEY DR
Practice Address - Street 2:
Practice Address - City:EASLEY
Practice Address - State:SC
Practice Address - Zip Code:29642-3578
Practice Address - Country:US
Practice Address - Phone:864-421-5177
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-03
Last Update Date:2019-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3274224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant