Provider Demographics
NPI:1356081418
Name:ALLEN, HOLLY CAPRICE (GED)
Entity Type:Individual
Prefix:
First Name:HOLLY
Middle Name:CAPRICE
Last Name:ALLEN
Suffix:
Gender:F
Credentials:GED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 815
Mailing Address - Street 2:
Mailing Address - City:RIVERTON
Mailing Address - State:WY
Mailing Address - Zip Code:82501-0116
Mailing Address - Country:US
Mailing Address - Phone:307-851-5178
Mailing Address - Fax:
Practice Address - Street 1:1022 E ROOSEVELT AVE
Practice Address - Street 2:
Practice Address - City:RIVERTON
Practice Address - State:WY
Practice Address - Zip Code:82501-2940
Practice Address - Country:US
Practice Address - Phone:307-851-5178
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-29
Last Update Date:2022-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XM0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistMental Health