Provider Demographics
NPI:1386068815
Name:HALL, TANYA JEAN (COTA/L)
Entity type:Individual
Prefix:
First Name:TANYA
Middle Name:JEAN
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 1:1210 E BOGART RD
Mailing Address - Street 2:
Mailing Address - City:SANDUSKY
Mailing Address - State:OH
Mailing Address - Zip Code:44870-6411
Mailing Address - Country:US
Mailing Address - Phone:419-627-3900
Mailing Address - Fax:
Practice Address - Street 1:5200 COUNTY ROAD 13
Practice Address - Street 2:
Practice Address - City:KANSAS
Practice Address - State:OH
Practice Address - Zip Code:44841-9617
Practice Address - Country:US
Practice Address - Phone:419-986-6640
Practice Address - Fax:419-986-6651
Is Sole Proprietor?:No
Enumeration Date:2014-02-04
Last Update Date:2016-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOTA.04661224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant