Provider Demographics
NPI:1073891560
Name:HOLLOWAY, CLAUDINE MARIE (MS OTR/L)
Entity Type:Individual
Prefix:
First Name:CLAUDINE
Middle Name:MARIE
Last Name:HOLLOWAY
Suffix:
Gender:F
Credentials:MS OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:719 REBA PL
Mailing Address - Street 2:#2 S
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60202-4115
Mailing Address - Country:US
Mailing Address - Phone:847-570-9879
Mailing Address - Fax:
Practice Address - Street 1:719 REBA PL
Practice Address - Street 2:#2 S
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60202-4115
Practice Address - Country:US
Practice Address - Phone:847-570-9879
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-01
Last Update Date:2011-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056004020225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist