Provider Demographics
NPI:1225609795
Name:ROSS, HOLLY M (BS/MOT/OTRL/WSI)
Entity Type:Individual
Prefix:
First Name:HOLLY
Middle Name:M
Last Name:ROSS
Suffix:
Gender:F
Credentials:BS/MOT/OTRL/WSI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 W LITTLETON BLVD STE 210-105
Mailing Address - Street 2:
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80120-2478
Mailing Address - Country:US
Mailing Address - Phone:720-610-9928
Mailing Address - Fax:
Practice Address - Street 1:40 W LITTLETON BLVD
Practice Address - Street 2:SUITE 210-105
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80120
Practice Address - Country:US
Practice Address - Phone:720-610-9928
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-06
Last Update Date:2021-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COOT.0005668225XP0200X, 225X00000X, 225XF0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
No225XF0002XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistFeeding, Eating & Swallowing
Provider Identifiers
StateIdentifier IDID TypeIssuer
40862OtherNBCOT LICENSE NUMBER
MI5201010613OtherMICHIGAN STATE LICENSE
COOT.0005668OtherCOLORADO STATE LICENSE NUMBER