Provider Demographics
NPI:1326294406
Name:HOLLAND, DEIDRA S (MSOT, EDD)
Entity Type:Individual
Prefix:
First Name:DEIDRA
Middle Name:S
Last Name:HOLLAND
Suffix:
Gender:F
Credentials:MSOT, EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4817 DUNBERRY LN
Mailing Address - Street 2:
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55435-1536
Mailing Address - Country:US
Mailing Address - Phone:952-956-2467
Mailing Address - Fax:
Practice Address - Street 1:360 COLBORNE ST
Practice Address - Street 2:SPPS ADMIN
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55102-3228
Practice Address - Country:US
Practice Address - Phone:952-956-2467
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-08
Last Update Date:2013-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN103636225X00000X, 225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics