Provider Demographics
NPI:1467756510
Name:BICKERSTAFFE, HOLLY ANN (LMT)
Entity Type:Individual
Prefix:
First Name:HOLLY
Middle Name:ANN
Last Name:BICKERSTAFFE
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 WILSON ST
Mailing Address - Street 2:SUITE 5
Mailing Address - City:CHELMSFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01824-3164
Mailing Address - Country:US
Mailing Address - Phone:978-265-3698
Mailing Address - Fax:
Practice Address - Street 1:17 WILSON ST
Practice Address - Street 2:SUITE 5
Practice Address - City:CHELMSFORD
Practice Address - State:MA
Practice Address - Zip Code:01824-3164
Practice Address - Country:US
Practice Address - Phone:978-265-3698
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-04
Last Update Date:2011-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3755225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist