Provider Demographics
NPI:1073739637
Name:HOLLAND, SHERRY LEE (MA)
Entity Type:Individual
Prefix:
First Name:SHERRY
Middle Name:LEE
Last Name:HOLLAND
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:453 PATTERSON FERRY RD
Mailing Address - Street 2:
Mailing Address - City:CALVERT CITY
Mailing Address - State:KY
Mailing Address - Zip Code:42029-8616
Mailing Address - Country:US
Mailing Address - Phone:270-527-1048
Mailing Address - Fax:270-527-5322
Practice Address - Street 1:453 PATTERSON FERRY RD
Practice Address - Street 2:
Practice Address - City:CALVERT CITY
Practice Address - State:KY
Practice Address - Zip Code:42029-8616
Practice Address - Country:US
Practice Address - Phone:270-527-1048
Practice Address - Fax:270-527-5322
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-18
Last Update Date:2014-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY200150372222Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY200150372OtherEPSD ID