Provider Demographics
NPI:1144399015
Name:HOLDERBACH, HANNEKE JAMIESON (COTA/L)
Entity Type:Individual
Prefix:MRS
First Name:HANNEKE
Middle Name:JAMIESON
Last Name:HOLDERBACH
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:MS
Other - First Name:HANNEKE
Other - Middle Name:JANET
Other - Last Name:JAMIESON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5701 SW MULTNOMAH BLVD
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97219-3195
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5701 SW MULTNOMAH BLVD
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97219-3195
Practice Address - Country:US
Practice Address - Phone:503-244-1107
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2017-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0730113076224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant