Provider Demographics
NPI:1376663518
Name:HALLERAN, PATRICIA SUE (OTRL)
Entity Type:Individual
Prefix:MRS
First Name:PATRICIA
Middle Name:SUE
Last Name:HALLERAN
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:371 PRAIRIE VIEW CIR
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:IA
Mailing Address - Zip Code:52228-9504
Mailing Address - Country:US
Mailing Address - Phone:319-845-4033
Mailing Address - Fax:
Practice Address - Street 1:301 NE TRILEIN DR STE 4
Practice Address - Street 2:
Practice Address - City:ANKENY
Practice Address - State:IA
Practice Address - Zip Code:50021-2170
Practice Address - Country:US
Practice Address - Phone:319-366-8714
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA01165225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist