Provider Demographics
NPI:1194093245
Name:HALL, KIM ANNE (MS, OTR/L)
Entity type:Individual
Prefix:
First Name:KIM
Middle Name:ANNE
Last Name:HALL
Suffix:
Gender:F
Credentials:MS, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:136 CHLORINATOR RD
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:NY
Mailing Address - Zip Code:13807-1130
Mailing Address - Country:US
Mailing Address - Phone:315-525-8084
Mailing Address - Fax:
Practice Address - Street 1:136 CHLORINATOR RD
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:NY
Practice Address - Zip Code:13807-1130
Practice Address - Country:US
Practice Address - Phone:315-525-8084
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-05
Last Update Date:2014-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010463-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist