Provider Demographics
NPI:1568963049
Name:HOLLAND, ELIZABETH RENEE (OTA)
Entity Type:Individual
Prefix:MISS
First Name:ELIZABETH
Middle Name:RENEE
Last Name:HOLLAND
Suffix:
Gender:F
Credentials:OTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1875 POST OAK PARK DR APT 721
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77027-3471
Mailing Address - Country:US
Mailing Address - Phone:713-419-4803
Mailing Address - Fax:
Practice Address - Street 1:1875 POST OAK PARK DR APT 721
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77027-3471
Practice Address - Country:US
Practice Address - Phone:713-419-4803
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-21
Last Update Date:2018-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX212676208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics