Provider Demographics
NPI:1255591525
Name:O HALLORAN, CAILIN MARIE
Entity type:Individual
Prefix:
First Name:CAILIN
Middle Name:MARIE
Last Name:O HALLORAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CAILIN
Other - Middle Name:MARIE
Other - Last Name:O HALLORAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OTR
Mailing Address - Street 1:4597 W 8200 S
Mailing Address - Street 2:
Mailing Address - City:WEST JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84088-5939
Mailing Address - Country:US
Mailing Address - Phone:801-913-5505
Mailing Address - Fax:
Practice Address - Street 1:50 N MEDICAL DR
Practice Address - Street 2:ACUTE CARE THERAPY
Practice Address - City:SLC
Practice Address - State:UT
Practice Address - Zip Code:84132-0001
Practice Address - Country:US
Practice Address - Phone:801-581-2635
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-11
Last Update Date:2008-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT358431-4201225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist