Provider Demographics
NPI:1093020729
Name:CHARLTON, HOLLY ANN (OTR/L)
Entity Type:Individual
Prefix:MS
First Name:HOLLY
Middle Name:ANN
Last Name:CHARLTON
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:HOLLY
Other - Middle Name:A
Other - Last Name:WILLS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:19661 GREEN MOUNTAIN DR
Mailing Address - Street 2:
Mailing Address - City:NEWHALL
Mailing Address - State:CA
Mailing Address - Zip Code:91321-2147
Mailing Address - Country:US
Mailing Address - Phone:661-755-8072
Mailing Address - Fax:
Practice Address - Street 1:19661 GREEN MOUNTAIN DR
Practice Address - Street 2:
Practice Address - City:NEWHALL
Practice Address - State:CA
Practice Address - Zip Code:91321-2147
Practice Address - Country:US
Practice Address - Phone:661-755-8072
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-18
Last Update Date:2019-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1746225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist