Provider Demographics
NPI:1164573572
Name:PIGNOTTI, HOLLY LEE (OTRL)
Entity Type:Individual
Prefix:
First Name:HOLLY
Middle Name:LEE
Last Name:PIGNOTTI
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21029 ST JAMES CT
Mailing Address - Street 2:
Mailing Address - City:MOKENA
Mailing Address - State:IL
Mailing Address - Zip Code:60448-2016
Mailing Address - Country:US
Mailing Address - Phone:815-690-2570
Mailing Address - Fax:815-469-4496
Practice Address - Street 1:21029 ST JAMES CT
Practice Address - Street 2:
Practice Address - City:MOKENA
Practice Address - State:IL
Practice Address - Zip Code:60448-2016
Practice Address - Country:US
Practice Address - Phone:815-690-2570
Practice Address - Fax:815-469-4496
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist