Provider Demographics
NPI:1083059976
Name:STAP-GREGORY, HOLLY BARBARA (LMT)
Entity Type:Individual
Prefix:MRS
First Name:HOLLY
Middle Name:BARBARA
Last Name:STAP-GREGORY
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1450 W M 43 HWY
Mailing Address - Street 2:
Mailing Address - City:HASTINGS
Mailing Address - State:MI
Mailing Address - Zip Code:49058-7681
Mailing Address - Country:US
Mailing Address - Phone:269-945-2203
Mailing Address - Fax:
Practice Address - Street 1:1479 W DOWLING RD
Practice Address - Street 2:
Practice Address - City:DOWLING
Practice Address - State:MI
Practice Address - Zip Code:49050-9718
Practice Address - Country:US
Practice Address - Phone:616-498-8001
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-06
Last Update Date:2013-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7501000390174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist