Basic Information
| Provider Information | |||||||||
| NPI: | 1437823069 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HALL | ||||||||
| FirstName: | CARISA | ||||||||
| MiddleName: | KRISHINGNER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 109 SUFFOLK CT | ||||||||
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| City: | LONGWOOD | ||||||||
| State: | FL | ||||||||
| PostalCode: | 327795719 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8287025811 | ||||||||
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| Practice Location | |||||||||
| Address1: | 4780 DATA CT | ||||||||
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| City: | ORLANDO | ||||||||
| State: | FL | ||||||||
| PostalCode: | 328178331 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4079040133 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/06/2021 | ||||||||
| LastUpdateDate: | 08/06/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/06/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225XP0200X | OT21913 | FL | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Pediatrics |
No ID Information.