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Individual

MS. DIANE M. HALLORAN

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
O.T.

Contact information

Practice address
6320 W NORTH AVE, WAUWATOSA, WI 53213-2013
(414) 258-2981
Mailing address
6320 W NORTH AVE, WAUWATOSA, WI 53213-2013
(414) 258-2981

Taxonomy

Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
992-026
WI

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
40523600
WI
Enumeration date
01/11/2007
Last updated
07/09/2007
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