Individual
BRIAN HALOG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
4560 SE INTERNATIONAL WAY STE 100, MILWAUKIE, OR 97222-4628
(971) 206-5202
Mailing address
836 FRUIT STAND CIR, VACAVILLE, CA 95688-2570
(209) 406-4996
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
4258
CA
Other
Enumeration date
08/16/2022
Last updated
08/16/2022
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