Provider Demographics
NPI:1801091632
Name:HALL, KATHY MARIE (COTA,PTA)
Entity type:Individual
Prefix:MS
First Name:KATHY
Middle Name:MARIE
Last Name:HALL
Suffix:
Gender:F
Credentials:COTA,PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4060 OMER RD
Mailing Address - Street 2:
Mailing Address - City:DIVIDE
Mailing Address - State:CO
Mailing Address - Zip Code:80814-8801
Mailing Address - Country:US
Mailing Address - Phone:719-250-0543
Mailing Address - Fax:
Practice Address - Street 1:4060 OMER RD
Practice Address - Street 2:
Practice Address - City:DIVIDE
Practice Address - State:CO
Practice Address - Zip Code:80814-8801
Practice Address - Country:US
Practice Address - Phone:719-250-0543
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-20
Last Update Date:2011-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMA-0570174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist