Provider Demographics
NPI:1073812665
Name:HOLDSWORTH, ELISABETH GERALYN (PTA, COTA/L)
Entity Type:Individual
Prefix:MS
First Name:ELISABETH
Middle Name:GERALYN
Last Name:HOLDSWORTH
Suffix:
Gender:F
Credentials:PTA, COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:895 PORTLAND ROAD
Mailing Address - Street 2:
Mailing Address - City:SACO
Mailing Address - State:ME
Mailing Address - Zip Code:04072
Mailing Address - Country:US
Mailing Address - Phone:207-439-5104
Mailing Address - Fax:207-571-8134
Practice Address - Street 1:895 PORTLAND ROAD
Practice Address - Street 2:
Practice Address - City:SACO
Practice Address - State:ME
Practice Address - Zip Code:04072
Practice Address - Country:US
Practice Address - Phone:207-439-5104
Practice Address - Fax:207-571-8134
Is Sole Proprietor?:No
Enumeration Date:2011-03-22
Last Update Date:2011-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPA3647225200000X, 174400000X
ME0A2499224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
No224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant
No174400000XOther Service ProvidersSpecialist