Provider Demographics
NPI:1336296821
Name:KASAVANA, HOLLY LYNN (ATC)
Entity Type:Individual
Prefix:
First Name:HOLLY
Middle Name:LYNN
Last Name:KASAVANA
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5123 BARTON RD
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSTON
Mailing Address - State:MI
Mailing Address - Zip Code:48895-9304
Mailing Address - Country:US
Mailing Address - Phone:517-655-4663
Mailing Address - Fax:
Practice Address - Street 1:131 DUFFY DAUGHERTY BLDG
Practice Address - Street 2:MICHIGAN STATE UNIVERSITY
Practice Address - City:EAST LANSING
Practice Address - State:MI
Practice Address - Zip Code:48824
Practice Address - Country:US
Practice Address - Phone:517-353-4369
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer