Provider Demographics
NPI:1467490938
Name:MILLARD, HOLLY BAYES (OT)
Entity Type:Individual
Prefix:MRS
First Name:HOLLY
Middle Name:BAYES
Last Name:MILLARD
Suffix:
Gender:F
Credentials:OT
Other - Prefix:MS
Other - First Name:HOLLY
Other - Middle Name:ANN
Other - Last Name:BAYES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OT
Mailing Address - Street 1:601 JOHN ST
Mailing Address - Street 2:SUITE M-230
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49007-5341
Mailing Address - Country:US
Mailing Address - Phone:269-349-8601
Mailing Address - Fax:269-349-6446
Practice Address - Street 1:601 JOHN ST
Practice Address - Street 2:SUITE M-230
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49007-5341
Practice Address - Country:US
Practice Address - Phone:269-349-8601
Practice Address - Fax:269-349-6446
Is Sole Proprietor?:No
Enumeration Date:2006-06-04
Last Update Date:2014-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5201005581225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI670C900250OtherBCBS
155812OtherGREAT LAKES HLTH PLN
155812OtherGREAT LAKES HLTH PLN
155812OtherGREAT LAKES HLTH PLN