Provider Demographics
NPI:1093803637
Name:CLEMENT, HOLLY I (OTR)
Entity Type:Individual
Prefix:
First Name:HOLLY
Middle Name:I
Last Name:CLEMENT
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:HOLLY
Other - Middle Name:
Other - Last Name:DORNEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2774 PUESTA DEL SOL
Mailing Address - Street 2:
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93105-2957
Mailing Address - Country:US
Mailing Address - Phone:805-452-4590
Mailing Address - Fax:
Practice Address - Street 1:2774 PUESTA DEL SOL
Practice Address - Street 2:
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93105-2957
Practice Address - Country:US
Practice Address - Phone:805-452-4590
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2013-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOT8070225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWOT8070AMedicare PIN
CAWOT8070BMedicare PIN