Healthcare Provider Details

I. General information

NPI: 1619005147
Provider Name (Legal Business Name): MEGAN PATRICIA HALLIGAN OTRL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/28/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1441 CLIFTON RD NE
ATLANTA GA
30322-1004
US

IV. Provider business mailing address

4282 ROSWELL RD NE APT A-4
ATLANTA GA
30342-3719
US

V. Phone/Fax

Practice location:
  • Phone: 404-712-5512
  • Fax:
Mailing address:
  • Phone: 404-277-6427
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number002617
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: