Provider Demographics
NPI:1508223132
Name:ISELER -MABON, HOLLY (OTR)
Entity Type:Individual
Prefix:
First Name:HOLLY
Middle Name:
Last Name:ISELER -MABON
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 E MICHELTORENA ST UNIT 78
Mailing Address - Street 2:
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93103-1984
Mailing Address - Country:US
Mailing Address - Phone:260-413-9368
Mailing Address - Fax:
Practice Address - Street 1:900 CALLE DE LOS AMIGOS
Practice Address - Street 2:
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93105-4435
Practice Address - Country:US
Practice Address - Phone:260-413-9368
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-27
Last Update Date:2023-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12919225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist