Provider Demographics
NPI:1568769495
Name:HOLLOWAY, ELIZABETH ANNETTE (COTA/L)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:ANNETTE
Last Name:HOLLOWAY
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8800 E 59TH ST
Mailing Address - Street 2:
Mailing Address - City:RAYTOWN
Mailing Address - State:MO
Mailing Address - Zip Code:64133-3702
Mailing Address - Country:US
Mailing Address - Phone:816-353-9254
Mailing Address - Fax:
Practice Address - Street 1:8800 E 59TH ST
Practice Address - Street 2:
Practice Address - City:RAYTOWN
Practice Address - State:MO
Practice Address - Zip Code:64133-3702
Practice Address - Country:US
Practice Address - Phone:816-353-9254
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-02-10
Last Update Date:2011-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO000792224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO000792OtherMISSOURI STATE LISCENSE