Provider Demographics
NPI:1639146608
Name:DIEGIDIO-HALLADAY, MILDRED (OT)
Entity Type:Individual
Prefix:MS
First Name:MILDRED
Middle Name:
Last Name:DIEGIDIO-HALLADAY
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1090 WILDMAN AVE
Mailing Address - Street 2:
Mailing Address - City:BENSALEM
Mailing Address - State:PA
Mailing Address - Zip Code:19020
Mailing Address - Country:US
Mailing Address - Phone:215-638-2594
Mailing Address - Fax:
Practice Address - Street 1:90 WEST AFTON AVE
Practice Address - Street 2:SUITE G 5 AND 6
Practice Address - City:YARDLEY
Practice Address - State:PA
Practice Address - Zip Code:19067
Practice Address - Country:US
Practice Address - Phone:215-493-2666
Practice Address - Fax:215-493-6639
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC004357L225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1011857350001Medicaid
096958Medicare ID - Type Unspecified