Provider Demographics
NPI:1184956633
Name:MACFADYEN-HALLORAN, GERALDINE ANN (OT)
Entity type:Individual
Prefix:
First Name:GERALDINE
Middle Name:ANN
Last Name:MACFADYEN-HALLORAN
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:GERALDINE
Other - Middle Name:ANN
Other - Last Name:HALLORAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OT
Mailing Address - Street 1:5500 ARMSTRONG RD
Mailing Address - Street 2:
Mailing Address - City:BATTLE CREEK
Mailing Address - State:MI
Mailing Address - Zip Code:49037-7314
Mailing Address - Country:US
Mailing Address - Phone:269-223-5303
Mailing Address - Fax:269-223-6096
Practice Address - Street 1:5500 ARMSTRONG RD
Practice Address - Street 2:
Practice Address - City:BATTLE CREEK
Practice Address - State:MI
Practice Address - Zip Code:49037-7314
Practice Address - Country:US
Practice Address - Phone:269-223-5303
Practice Address - Fax:269-223-6096
Is Sole Proprietor?:No
Enumeration Date:2010-02-09
Last Update Date:2010-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5201003631225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist