Provider Demographics
NPI:1184180648
Name:HOLLADAY, DIANE (OTR)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:
Last Name:HOLLADAY
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15722 IBISRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:LITHIA
Mailing Address - State:FL
Mailing Address - Zip Code:33547-3893
Mailing Address - Country:US
Mailing Address - Phone:317-509-4940
Mailing Address - Fax:
Practice Address - Street 1:417 COMMERCIAL CT STE C
Practice Address - Street 2:
Practice Address - City:VENICE
Practice Address - State:FL
Practice Address - Zip Code:34292-1655
Practice Address - Country:US
Practice Address - Phone:941-485-0121
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-20
Last Update Date:2020-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN31006806A225X00000X
FL20037225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist