Provider Demographics
NPI:1043504418
Name:FROLEK, HOLLY LYNN (MOT, OTR/L)
Entity Type:Individual
Prefix:
First Name:HOLLY
Middle Name:LYNN
Last Name:FROLEK
Suffix:
Gender:F
Credentials:MOT, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15430 85TH ST SE
Mailing Address - Street 2:
Mailing Address - City:LIDGERWOOD
Mailing Address - State:ND
Mailing Address - Zip Code:58053-9511
Mailing Address - Country:US
Mailing Address - Phone:701-640-5345
Mailing Address - Fax:
Practice Address - Street 1:15430 85TH ST SE
Practice Address - Street 2:
Practice Address - City:LIDGERWOOD
Practice Address - State:ND
Practice Address - Zip Code:58053-9511
Practice Address - Country:US
Practice Address - Phone:701-640-5345
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-02
Last Update Date:2011-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056.009267225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist