Provider Demographics
NPI:1184868150
Name:HOLT, JEREMY PRESTON (OTR/L)
Entity Type:Individual
Prefix:MR
First Name:JEREMY
Middle Name:PRESTON
Last Name:HOLT
Suffix:
Gender:M
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6186 DELORES BLVD
Mailing Address - Street 2:
Mailing Address - City:BROOK PARK
Mailing Address - State:OH
Mailing Address - Zip Code:44142-2721
Mailing Address - Country:US
Mailing Address - Phone:216-650-6819
Mailing Address - Fax:
Practice Address - Street 1:10701 EAST BLVD
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44106-1702
Practice Address - Country:US
Practice Address - Phone:216-791-3800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-04-22
Last Update Date:2009-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH007241225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist