Provider Demographics
NPI:1386131621
Name:HALL, KERLENA (COTA,CLT)
Entity type:Individual
Prefix:
First Name:KERLENA
Middle Name:
Last Name:HALL
Suffix:
Gender:F
Credentials:COTA,CLT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17671 ADDISON RD APT 2904
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75287-7032
Mailing Address - Country:US
Mailing Address - Phone:786-587-6193
Mailing Address - Fax:
Practice Address - Street 1:8600 SKYLINE DR
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75243-4198
Practice Address - Country:US
Practice Address - Phone:786-587-6193
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-20
Last Update Date:2018-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX211335225XP0019X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0019XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPhysical Rehabilitation