Provider Demographics
NPI:1427692383
Name:HALLAM, DOUGLAS A (COTA/L)
Entity type:Individual
Prefix:MR
First Name:DOUGLAS
Middle Name:A
Last Name:HALLAM
Suffix:
Gender:M
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 1:46 PETERSON CT
Mailing Address - Street 2:
Mailing Address - City:PEARL RIVER
Mailing Address - State:NY
Mailing Address - Zip Code:10965-2865
Mailing Address - Country:US
Mailing Address - Phone:845-558-0185
Mailing Address - Fax:
Practice Address - Street 1:2700 WESTCHESTER AVE STE 300
Practice Address - Street 2:
Practice Address - City:PURCHASE
Practice Address - State:NY
Practice Address - Zip Code:10577-2554
Practice Address - Country:US
Practice Address - Phone:914-323-2868
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-04
Last Update Date:2019-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010228224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant