Provider Demographics
NPI:1225427578
Name:BURNER, HOLLY (LMT)
Entity Type:Individual
Prefix:
First Name:HOLLY
Middle Name:
Last Name:BURNER
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6651 FRANK AVE NW
Mailing Address - Street 2:
Mailing Address - City:NORTH CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44720-8442
Mailing Address - Country:US
Mailing Address - Phone:330-498-9865
Mailing Address - Fax:330-498-9869
Practice Address - Street 1:6651 FRANK AVE NW
Practice Address - Street 2:
Practice Address - City:NORTH CANTON
Practice Address - State:OH
Practice Address - Zip Code:44720-8442
Practice Address - Country:US
Practice Address - Phone:330-498-9865
Practice Address - Fax:330-498-9869
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-09
Last Update Date:2015-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH33.008580-A-B208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine