Basic Information
| Provider Information | |||||||||
| NPI: | 1154050151 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HALL | ||||||||
| FirstName: | SAMANTHA | ||||||||
| MiddleName: | JEAN | ||||||||
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| Credential: | COTA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 170 PATTESON ST | ||||||||
| Address2: | |||||||||
| City: | BECKLEY | ||||||||
| State: | WV | ||||||||
| PostalCode: | 258019623 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3042544206 | ||||||||
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| Practice Location | |||||||||
| Address1: | 152 SADDLESHOP ROAD | ||||||||
| Address2: | |||||||||
| City: | HILLTOP | ||||||||
| State: | WV | ||||||||
| PostalCode: | 25855 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3044692966 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/07/2022 | ||||||||
| LastUpdateDate: | 06/07/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 05/28/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 224Z00000X | WV | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapy Assistant |
No ID Information.