Provider Demographics
NPI:1497126171
Name:HOLLY, KAILEE (MT-BC)
Entity Type:Individual
Prefix:
First Name:KAILEE
Middle Name:
Last Name:HOLLY
Suffix:
Gender:F
Credentials:MT-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6B SPENCER AVE
Mailing Address - Street 2:
Mailing Address - City:MANITOU SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80829
Mailing Address - Country:US
Mailing Address - Phone:630-730-3627
Mailing Address - Fax:
Practice Address - Street 1:6B SPENCER AVE
Practice Address - Street 2:
Practice Address - City:MANITOU SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80829
Practice Address - Country:US
Practice Address - Phone:630-730-3627
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-07
Last Update Date:2015-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO12050225A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist