Provider Demographics
NPI:1346714631
Name:HOLDORF, MATTHEW (COTA)
Entity Type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:
Last Name:HOLDORF
Suffix:
Gender:M
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4357 WINCHESTER RD
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:PA
Mailing Address - Zip Code:17315-3441
Mailing Address - Country:US
Mailing Address - Phone:717-309-4604
Mailing Address - Fax:
Practice Address - Street 1:970 COLONIAL AVE
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17403-3430
Practice Address - Country:US
Practice Address - Phone:717-845-2661
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-20
Last Update Date:2019-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOP008614224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant