Provider Demographics
NPI:1366791642
Name:HALL, COLLEEN PATRICIA (COTA/L)
Entity type:Individual
Prefix:MRS
First Name:COLLEEN
Middle Name:PATRICIA
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 1:13604 MARIA DR
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:FL
Mailing Address - Zip Code:34667-1547
Mailing Address - Country:US
Mailing Address - Phone:727-534-4587
Mailing Address - Fax:
Practice Address - Street 1:13604 MARIA DR
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:FL
Practice Address - Zip Code:34667-1547
Practice Address - Country:US
Practice Address - Phone:727-534-4587
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-02
Last Update Date:2012-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOTA 8047224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant