Provider Demographics
NPI:1164861563
Name:KOROLESKI, HOLLY LYNN (OTR/L, CBIS)
Entity Type:Individual
Prefix:MS
First Name:HOLLY
Middle Name:LYNN
Last Name:KOROLESKI
Suffix:
Gender:F
Credentials:OTR/L, CBIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2707 ASHMAN ST
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48640-4449
Mailing Address - Country:US
Mailing Address - Phone:989-631-1100
Mailing Address - Fax:
Practice Address - Street 1:2707 ASHMAN ST
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:MI
Practice Address - Zip Code:48640-4449
Practice Address - Country:US
Practice Address - Phone:989-631-1100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-19
Last Update Date:2013-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5201005842225XN1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XN1300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistNeurorehabilitation