Provider Demographics
NPI:1467118539
Name:NOVAK, HOLLY (COTA/L)
Entity Type:Individual
Prefix:
First Name:HOLLY
Middle Name:
Last Name:NOVAK
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:490 LONE HORN PT
Mailing Address - Street 2:
Mailing Address - City:MONUMENT
Mailing Address - State:CO
Mailing Address - Zip Code:80132-9529
Mailing Address - Country:US
Mailing Address - Phone:720-495-8205
Mailing Address - Fax:
Practice Address - Street 1:490 LONE HORN PT
Practice Address - Street 2:
Practice Address - City:MONUMENT
Practice Address - State:CO
Practice Address - Zip Code:80132-9529
Practice Address - Country:US
Practice Address - Phone:720-495-8205
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-12
Last Update Date:2021-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COOTA.0001398224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant