Provider Demographics
NPI:1407974033
Name:WISSNER, HOLLY L (OTRL)
Entity Type:Individual
Prefix:MRS
First Name:HOLLY
Middle Name:L
Last Name:WISSNER
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:751 SHENANGO RD
Mailing Address - Street 2:
Mailing Address - City:BEAVER FALLS
Mailing Address - State:PA
Mailing Address - Zip Code:15010
Mailing Address - Country:US
Mailing Address - Phone:724-891-7378
Mailing Address - Fax:724-891-7378
Practice Address - Street 1:3023 WILMINGTON RD
Practice Address - Street 2:
Practice Address - City:NEW CASTLE
Practice Address - State:PA
Practice Address - Zip Code:16105
Practice Address - Country:US
Practice Address - Phone:724-656-8814
Practice Address - Fax:724-656-8815
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC004879L225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1015390640001OtherMEDICAL ASSISTANCE NUMBER