Provider Demographics
NPI:1346396900
Name:MCDANNOLD, HOLLY CHRISTA (MS, OTR L)
Entity Type:Individual
Prefix:MRS
First Name:HOLLY
Middle Name:CHRISTA
Last Name:MCDANNOLD
Suffix:
Gender:F
Credentials:MS, OTR L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10331 MEADOW WOOD CT
Mailing Address - Street 2:
Mailing Address - City:PRAIRIE HOME
Mailing Address - State:MO
Mailing Address - Zip Code:65068-2334
Mailing Address - Country:US
Mailing Address - Phone:573-268-4351
Mailing Address - Fax:
Practice Address - Street 1:10331 MEADOW WOOD CT
Practice Address - Street 2:
Practice Address - City:PRAIRIE HOME
Practice Address - State:MO
Practice Address - Zip Code:65068-2334
Practice Address - Country:US
Practice Address - Phone:573-268-4351
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-26
Last Update Date:2011-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2001000030225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO475275632Medicaid