Provider Demographics
NPI:1043413644
Name:HOLDEN, LATRENA D (OT)
Entity Type:Individual
Prefix:MS
First Name:LATRENA
Middle Name:D
Last Name:HOLDEN
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:256 PARKLAWN BLVD
Mailing Address - Street 2:APT. K
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43213-3813
Mailing Address - Country:US
Mailing Address - Phone:614-861-3638
Mailing Address - Fax:
Practice Address - Street 1:5020 REED RD
Practice Address - Street 2:SUITE C
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43220-2581
Practice Address - Country:US
Practice Address - Phone:614-284-4223
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH004995305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH331156222OtherEIN