Provider Demographics
NPI:1730248725
Name:HALLORAN, CINDY CAROLE (OTR)
Entity type:Individual
Prefix:
First Name:CINDY
Middle Name:CAROLE
Last Name:HALLORAN
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 SPRING DR
Mailing Address - Street 2:
Mailing Address - City:MAUMELLE
Mailing Address - State:AR
Mailing Address - Zip Code:72113-6381
Mailing Address - Country:US
Mailing Address - Phone:501-851-8598
Mailing Address - Fax:
Practice Address - Street 1:304 SORENSON ST
Practice Address - Street 2:
Practice Address - City:NORTH LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72118-3473
Practice Address - Country:US
Practice Address - Phone:501-246-5191
Practice Address - Fax:501-246-5393
Is Sole Proprietor?:No
Enumeration Date:2006-12-06
Last Update Date:2016-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AROTR410225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR115928721Medicaid