Provider Demographics
NPI:1376840652
Name:MAHONEY, HOLLY FAE (OTR/L)
Entity Type:Individual
Prefix:
First Name:HOLLY
Middle Name:FAE
Last Name:MAHONEY
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:HOLLY
Other - Middle Name:FAE
Other - Last Name:BRYDL-ANDREWS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ORT/L, SCEM
Mailing Address - Street 1:2500 NE 65TH AVE
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98661-6812
Mailing Address - Country:US
Mailing Address - Phone:402-641-0919
Mailing Address - Fax:
Practice Address - Street 1:2500 NE 65TH AVE
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98661-6812
Practice Address - Country:US
Practice Address - Phone:402-641-0919
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-22
Last Update Date:2016-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR281069225X00000X, 225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist