Provider Demographics
NPI:1174120679
Name:HALE, CARLA JO (BS, CRT)
Entity type:Individual
Prefix:
First Name:CARLA
Middle Name:JO
Last Name:HALE
Suffix:
Gender:F
Credentials:BS, CRT
Other - Prefix:
Other - First Name:CARLA
Other - Middle Name:JO
Other - Last Name:CHRISTOPHERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRT
Mailing Address - Street 1:2993 NEW ROE RD
Mailing Address - Street 2:
Mailing Address - City:ADOLPHUS
Mailing Address - State:KY
Mailing Address - Zip Code:42120-6204
Mailing Address - Country:US
Mailing Address - Phone:270-850-5359
Mailing Address - Fax:
Practice Address - Street 1:2993 NEW ROE RD
Practice Address - Street 2:
Practice Address - City:ADOLPHUS
Practice Address - State:KY
Practice Address - Zip Code:42120-6204
Practice Address - Country:US
Practice Address - Phone:270-850-5359
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-07
Last Update Date:2020-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY5138227800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes227800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, Certified