Provider Demographics
NPI:1376631994
Name:GUENETTE, HOLLY (OTRL CHT)
Entity Type:Individual
Prefix:MRS
First Name:HOLLY
Middle Name:
Last Name:GUENETTE
Suffix:
Gender:F
Credentials:OTRL CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2538 CAMINO ENTRADA STE 300
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87507-4927
Mailing Address - Country:US
Mailing Address - Phone:505-424-1239
Mailing Address - Fax:888-746-4761
Practice Address - Street 1:2538 CAMINO ENTRADA STE 300
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87507-4927
Practice Address - Country:US
Practice Address - Phone:505-424-1239
Practice Address - Fax:888-746-4761
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2012-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMOT 2585225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL891854600OtherMEDICAID
FL890472301Medicaid
FLZ096UOtherBCBS PROVIDER NUMBER
Z096UZMedicare PIN