Provider Demographics
NPI:1043967037
Name:MCHOLLAND, MICAH JANE (OTR/L)
Entity Type:Individual
Prefix:
First Name:MICAH
Middle Name:JANE
Last Name:MCHOLLAND
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:MICAH
Other - Middle Name:JANE
Other - Last Name:CULBERTSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:COTA/L
Mailing Address - Street 1:205 TYLER CT
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:MO
Mailing Address - Zip Code:65712-7845
Mailing Address - Country:US
Mailing Address - Phone:573-822-0685
Mailing Address - Fax:
Practice Address - Street 1:205 TYLER CT
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:MO
Practice Address - Zip Code:65712-7845
Practice Address - Country:US
Practice Address - Phone:573-822-0685
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-09
Last Update Date:2022-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2022005834225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist