Provider Demographics
NPI:1467788588
Name:HOLLENBECK, PAUL LEON (OTR)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:LEON
Last Name:HOLLENBECK
Suffix:
Gender:M
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:415 EMBASSY AVE
Mailing Address - Street 2:
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93458-1020
Mailing Address - Country:US
Mailing Address - Phone:805-361-0621
Mailing Address - Fax:805-361-0625
Practice Address - Street 1:415 EMBASSY AVE
Practice Address - Street 2:
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93458-1020
Practice Address - Country:US
Practice Address - Phone:805-361-0621
Practice Address - Fax:805-361-0625
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-23
Last Update Date:2010-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOT10320225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist