Provider Demographics
NPI:1003911785
Name:HOLLISTER, RACHEL ESTHER (OT)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:ESTHER
Last Name:HOLLISTER
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:RACHEL
Other - Middle Name:ESTHER
Other - Last Name:DYRUD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OT
Mailing Address - Street 1:210 W GRANT ST
Mailing Address - Street 2:#122
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55403-2298
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2450 RIVERSIDE AVE
Practice Address - Street 2:SUITE R102
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55454-1450
Practice Address - Country:US
Practice Address - Phone:612-273-9400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2009-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN100399225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand