Provider Demographics
NPI:1477608461
Name:HOLSTEIN, MARY M (LOT)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:M
Last Name:HOLSTEIN
Suffix:
Gender:F
Credentials:LOT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:909 HEMLOCK TRL
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:TX
Mailing Address - Zip Code:76131-3551
Mailing Address - Country:US
Mailing Address - Phone:817-847-8412
Mailing Address - Fax:
Practice Address - Street 1:909 HEMLOCK TRL
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:TX
Practice Address - Zip Code:76131-3551
Practice Address - Country:US
Practice Address - Phone:817-847-8412
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX104978225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist