Basic Information
| Provider Information | |||||||||
| NPI: | 1881103968 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MCHALE | ||||||||
| FirstName: | NATALIE | ||||||||
| MiddleName: | MARIE | ||||||||
| NamePrefix: | |||||||||
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| Credential: | COTA/L | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | MCHALE | ||||||||
| OtherFirstName: | NATALIE | ||||||||
| OtherMiddleName: | MARIE | ||||||||
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| OtherCredential: | COTA/L | ||||||||
| OtherLastNameType: | 2 | ||||||||
| Mailing Information | |||||||||
| Address1: | 1617 3RD ST | ||||||||
| Address2: | |||||||||
| City: | NEPTUNE BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 322664912 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9044510594 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 9141 CYPRESS GREEN DR STE 2 | ||||||||
| Address2: | |||||||||
| City: | JACKSONVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 322562006 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9046471849 | ||||||||
| FaxNumber: | 9046472625 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/21/2017 | ||||||||
| LastUpdateDate: | 09/21/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 224Z00000X | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapy Assistant |
No ID Information.