Healthcare Provider Details

I. General information

NPI: 1649132259
Provider Name (Legal Business Name): HALLIE CHRISTINE CICCO OTD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/02/2025
Last Update Date: 12/02/2025
Certification Date: 12/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

993 BRODHEAD RD STE 10
MOON TOWNSHIP PA
15108-2306
US

IV. Provider business mailing address

993 BRODHEAD RD STE 10
MOON TOWNSHIP PA
15108-2306
US

V. Phone/Fax

Practice location:
  • Phone: 724-888-2548
  • Fax:
Mailing address:
  • Phone: 724-888-2548
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOC020862
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: