Provider Demographics
NPI:1215534540
Name:MCMAHON, HALIE ELLINGER (OTR/L)
Entity type:Individual
Prefix:
First Name:HALIE
Middle Name:ELLINGER
Last Name:MCMAHON
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:HALIE
Other - Middle Name:MADISON
Other - Last Name:ELLINGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OT
Mailing Address - Street 1:201 S ELLIOTT RD APT 637
Mailing Address - Street 2:
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27514-5979
Mailing Address - Country:US
Mailing Address - Phone:336-380-5763
Mailing Address - Fax:
Practice Address - Street 1:104 CELTIC CIR
Practice Address - Street 2:
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27516-4661
Practice Address - Country:US
Practice Address - Phone:336-380-5763
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-09
Last Update Date:2022-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC13594225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
443787OtherOCCUPATIONAL THERAPY CERTIFICATION #
NC13594OtherNORTH CAROLINA OCCUPATIONAL THERAPY LICENSE