Individual
MR. SHANE CARLOS HALL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
COTA
Contact information
Practice address
318 S ORANGE ST, MEDIA, PA 19063-3614
(610) 566-1400
Mailing address
318 S ORANGE ST, MEDIA, PA 19063-3614
(610) 566-1400
Taxonomy
Speciality
Code
Description
License number
State
224ZL0004X
Low Vision Occupational Therapy Assistant
Primary
OP008316
PA
Other
Enumeration date
02/12/2021
Last updated
02/12/2021
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