Shane Carlos Hall, COTA

Primary specialty

Low Vision Occupational Therapy AssistantTaxonomy code 224ZL0004X

License

OP008316 Issued in PA

Practice address

318 S Orange St
Media, PA 19063-3614

Phone

(610) 566-1400

NPI assigned

Feb 12, 2021

Last updated

Feb 12, 2021By the provider in NPPES

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1613088000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1613088000000",
    "number": "1205429073",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "318 S ORANGE ST",
            "city": "MEDIA",
            "state": "PA",
            "postal_code": "190633614",
            "telephone_number": "610-566-1400"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "318 S ORANGE ST",
            "city": "MEDIA",
            "state": "PA",
            "postal_code": "190633614",
            "telephone_number": "610-566-1400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HALL",
        "first_name": "SHANE",
        "middle_name": "CARLOS",
        "name_prefix": "Mr.",
        "credential": "COTA",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2021-02-12",
        "last_updated": "2021-02-12",
        "certification_date": "2021-02-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "224ZL0004X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Occupational Therapy Assistant, Low Vision",
            "state": "PA",
            "license": "OP008316",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Hagop L Derkrikorian, MD, PC
• Bryan Haimes, M.D.
• Emily Haindl
• Wendi Haldeman
• Amber Hall
• Kelly E Halloran, OTR/L
• Judith Anne Hammet-Kelly
• Valerie Nicole Hanft, MD
• Dayna Pizzigoni Hanna, PHD, LCPC, NCC, MS
• Allison T. Hannan, M.D.

• Occupational Therapy Assistant in Media, PA
• Providers in Media, PA by specialty
• Occupational Therapy Assistant in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 12, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.