Provider Demographics
NPI:1508228479
Name:THOMPSON, HOLLY (OTR/L)
Entity Type:Individual
Prefix:
First Name:HOLLY
Middle Name:
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:BDAACH
Mailing Address - Street 2:549TH HOSPITAL CENTER USAG HUMPHREY'S, BLDG #3030
Mailing Address - City:APO
Mailing Address - State:AP
Mailing Address - Zip Code:96271
Mailing Address - Country:US
Mailing Address - Phone:909-735-9036
Mailing Address - Fax:
Practice Address - Street 1:BDAACH
Practice Address - Street 2:549TH HOSPITAL CENTER USAG HUMPHREY'S, BLDG #3030
Practice Address - City:APO
Practice Address - State:AP
Practice Address - Zip Code:96271
Practice Address - Country:US
Practice Address - Phone:909-735-9036
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-22
Last Update Date:2020-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV12-0230225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist