Provider Demographics
NPI:1265849855
Name:HOLLENBECK, MARY KATHERINE (OTR)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:KATHERINE
Last Name:HOLLENBECK
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8040 LEFFERTS BLVD
Mailing Address - Street 2:4A
Mailing Address - City:KEW GARDENS
Mailing Address - State:NY
Mailing Address - Zip Code:11415-1723
Mailing Address - Country:US
Mailing Address - Phone:917-596-7149
Mailing Address - Fax:
Practice Address - Street 1:8040 LEFFERTS BLVD
Practice Address - Street 2:4A
Practice Address - City:KEW GARDENS
Practice Address - State:NY
Practice Address - Zip Code:11415-1723
Practice Address - Country:US
Practice Address - Phone:917-596-7149
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-16
Last Update Date:2014-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009585225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist