Provider Demographics
NPI:1235603283
Name:PHILLIPS, HOLLY FOSTER
Entity Type:Individual
Prefix:
First Name:HOLLY
Middle Name:FOSTER
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4785 RIDGE CREEK RD
Mailing Address - Street 2:
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42303-7816
Mailing Address - Country:US
Mailing Address - Phone:270-702-3688
Mailing Address - Fax:
Practice Address - Street 1:4785 RIDGE CREEK RD
Practice Address - Street 2:
Practice Address - City:OWENSBORO
Practice Address - State:KY
Practice Address - Zip Code:42303-7816
Practice Address - Country:US
Practice Address - Phone:270-702-3688
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-13
Last Update Date:2024-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY291221224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant