Provider Demographics
NPI:1144680836
Name:O'HALLORAN, LISA ANN (MS, OTR/L)
Entity type:Individual
Prefix:MRS
First Name:LISA
Middle Name:ANN
Last Name:O'HALLORAN
Suffix:
Gender:F
Credentials:MS, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1349 EAST 79TH.
Mailing Address - Street 2:EAST PROFESSIONAL CENTER/CMSD./ORS
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44103
Mailing Address - Country:US
Mailing Address - Phone:216-838-1961
Mailing Address - Fax:216-426-7900
Practice Address - Street 1:1349 EAST 79TH
Practice Address - Street 2:EAST PROFESSIONAL CENTER/CMSD/OFFICE OF RELATED SERVICE
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44103
Practice Address - Country:US
Practice Address - Phone:216-838-1961
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-24
Last Update Date:2016-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH01765225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics