Provider Demographics
NPI:1043754997
Name:ATLAKSON, HOLLY TERESA (COTA/L)
Entity Type:Individual
Prefix:MS
First Name:HOLLY
Middle Name:TERESA
Last Name:ATLAKSON
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:615 KICKAPOO ST
Mailing Address - Street 2:
Mailing Address - City:HIAWATHA
Mailing Address - State:KS
Mailing Address - Zip Code:66434-2419
Mailing Address - Country:US
Mailing Address - Phone:785-741-1945
Mailing Address - Fax:
Practice Address - Street 1:2112 HIGHWAY 36
Practice Address - Street 2:
Practice Address - City:WATHENA
Practice Address - State:KS
Practice Address - Zip Code:66090-4126
Practice Address - Country:US
Practice Address - Phone:785-989-3141
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-12-12
Last Update Date:2016-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS18-01376224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant