Provider Demographics
NPI:1164661310
Name:HOLT, SHARON RENELEE (MHS, OTR, CBIS)
Entity Type:Individual
Prefix:MRS
First Name:SHARON
Middle Name:RENELEE
Last Name:HOLT
Suffix:
Gender:F
Credentials:MHS, OTR, CBIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15523 OUTER DR
Mailing Address - Street 2:
Mailing Address - City:BATH
Mailing Address - State:MI
Mailing Address - Zip Code:48808-9737
Mailing Address - Country:US
Mailing Address - Phone:517-641-7182
Mailing Address - Fax:
Practice Address - Street 1:2775 E LANSING DR
Practice Address - Street 2:
Practice Address - City:EAST LANSING
Practice Address - State:MI
Practice Address - Zip Code:48823-7755
Practice Address - Country:US
Practice Address - Phone:517-332-1616
Practice Address - Fax:517-335-4797
Is Sole Proprietor?:No
Enumeration Date:2009-02-11
Last Update Date:2009-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5201006588225XN1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XN1300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistNeurorehabilitation