Provider Demographics
NPI:1295226488
Name:HOLADAY, MARK
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:HOLADAY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1895 BLUFF ST APT A
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80304-4286
Mailing Address - Country:US
Mailing Address - Phone:720-435-4341
Mailing Address - Fax:
Practice Address - Street 1:1895 BLUFF ST APT A
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80304-4286
Practice Address - Country:US
Practice Address - Phone:720-435-4341
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-23
Last Update Date:2024-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COOT-0005224225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI51005356904OtherPHYSICIANS PLUS INC