Provider Demographics
NPI:1871073676
Name:HALL, HEIDI LYNN (COTA)
Entity type:Individual
Prefix:
First Name:HEIDI
Middle Name:LYNN
Last Name:HALL
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1702 JUNIPER RIDGE LOOP
Mailing Address - Street 2:
Mailing Address - City:CEDAR PARK
Mailing Address - State:TX
Mailing Address - Zip Code:78613-1447
Mailing Address - Country:US
Mailing Address - Phone:512-632-7335
Mailing Address - Fax:
Practice Address - Street 1:540 E. HWY 29
Practice Address - Street 2:
Practice Address - City:BERTRAM
Practice Address - State:TX
Practice Address - Zip Code:78605
Practice Address - Country:US
Practice Address - Phone:512-355-2116
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-21
Last Update Date:2018-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX208756224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant