Provider Demographics
NPI:1093400533
Name:THOMAS, HOLLI DANIELLE
Entity Type:Individual
Prefix:
First Name:HOLLI
Middle Name:DANIELLE
Last Name:THOMAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 32
Mailing Address - Street 2:
Mailing Address - City:RUDOLPH
Mailing Address - State:OH
Mailing Address - Zip Code:43462-0032
Mailing Address - Country:US
Mailing Address - Phone:419-819-2623
Mailing Address - Fax:
Practice Address - Street 1:13918 CREEKVIEW DR LOT 58
Practice Address - Street 2:
Practice Address - City:RUDOLPH
Practice Address - State:OH
Practice Address - Zip Code:43462-9203
Practice Address - Country:US
Practice Address - Phone:419-819-2623
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-10
Last Update Date:2023-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker
No172A00000XOther Service ProvidersDriver
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No374U00000XNursing Service Related ProvidersHome Health Aide