Provider Demographics
NPI:1225281504
Name:HALLIDAY, MEGAN PITSTICK (MS OTR/L)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:PITSTICK
Last Name:HALLIDAY
Suffix:
Gender:F
Credentials:MS OTR/L
Other - Prefix:
Other - First Name:MEGAN
Other - Middle Name:CHERIE
Other - Last Name:PITSTICK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3823 E STATE ROAD 64
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34208-9041
Mailing Address - Country:US
Mailing Address - Phone:941-745-5111
Mailing Address - Fax:941-745-5667
Practice Address - Street 1:3823 E STATE ROAD 64
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34208-9041
Practice Address - Country:US
Practice Address - Phone:941-745-5111
Practice Address - Fax:941-745-5667
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-30
Last Update Date:2017-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT 13337225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist