Provider Demographics
NPI:1255858130
Name:BRECHEISEN, HOLLY (MOT/L)
Entity Type:Individual
Prefix:MRS
First Name:HOLLY
Middle Name:
Last Name:BRECHEISEN
Suffix:
Gender:F
Credentials:MOT/L
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 490
Mailing Address - Street 2:
Mailing Address - City:JUNCTION CITY
Mailing Address - State:KS
Mailing Address - Zip Code:66441-0490
Mailing Address - Country:US
Mailing Address - Phone:785-210-3363
Mailing Address - Fax:
Practice Address - Street 1:104 S WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:JUNCTION CITY
Practice Address - State:KS
Practice Address - Zip Code:66441-3557
Practice Address - Country:US
Practice Address - Phone:785-210-3363
Practice Address - Fax:785-210-3419
Is Sole Proprietor?:No
Enumeration Date:2017-08-23
Last Update Date:2019-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS17-01882225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist