Provider Demographics
NPI:1144737800
Name:HOLDERBAUM, KARLEIGH
Entity Type:Individual
Prefix:
First Name:KARLEIGH
Middle Name:
Last Name:HOLDERBAUM
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 1:10938 STUMP RD
Mailing Address - Street 2:
Mailing Address - City:MINERVA
Mailing Address - State:OH
Mailing Address - Zip Code:44657-9402
Mailing Address - Country:US
Mailing Address - Phone:330-205-4615
Mailing Address - Fax:
Practice Address - Street 1:10938 STUMP RD
Practice Address - Street 2:
Practice Address - City:MINERVA
Practice Address - State:OH
Practice Address - Zip Code:44657-9402
Practice Address - Country:US
Practice Address - Phone:330-205-4615
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-03
Last Update Date:2018-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer