Provider Demographics
NPI:1124200910
Name:HOLTBY, GLENNA CAROLINE
Entity Type:Individual
Prefix:
First Name:GLENNA
Middle Name:CAROLINE
Last Name:HOLTBY
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 1:260 CAVIAR ST STE A
Mailing Address - Street 2:
Mailing Address - City:KENAI
Mailing Address - State:AK
Mailing Address - Zip Code:99611-7738
Mailing Address - Country:US
Mailing Address - Phone:907-283-9016
Mailing Address - Fax:907-283-8438
Practice Address - Street 1:260 CAVIAR ST STE A
Practice Address - Street 2:
Practice Address - City:KENAI
Practice Address - State:AK
Practice Address - Zip Code:99611-7738
Practice Address - Country:US
Practice Address - Phone:907-283-9016
Practice Address - Fax:907-283-8438
Is Sole Proprietor?:No
Enumeration Date:2007-12-04
Last Update Date:2007-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK1562225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist