Provider Demographics
NPI:1235252479
Name:HOLLIDAY, BERTHA BROWN (OTRL)
Entity Type:Individual
Prefix:
First Name:BERTHA
Middle Name:BROWN
Last Name:HOLLIDAY
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5654
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91117-0654
Mailing Address - Country:US
Mailing Address - Phone:626-392-5634
Mailing Address - Fax:
Practice Address - Street 1:13652 CANTARA ST.
Practice Address - Street 2:BALBOA PLAZA
Practice Address - City:PANORAMA CITY
Practice Address - State:CA
Practice Address - Zip Code:91492
Practice Address - Country:US
Practice Address - Phone:818-832-7200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA6947225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist