Provider Demographics
NPI:1598268385
Name:HOLTSLAG, JAMES EDWARD (MOTR/L)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:EDWARD
Last Name:HOLTSLAG
Suffix:
Gender:M
Credentials:MOTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5342 HEATH AVE
Mailing Address - Street 2:
Mailing Address - City:CLARKSTON
Mailing Address - State:MI
Mailing Address - Zip Code:48346-3533
Mailing Address - Country:US
Mailing Address - Phone:248-765-1376
Mailing Address - Fax:
Practice Address - Street 1:5342 HEATH AVE
Practice Address - Street 2:
Practice Address - City:CLARKSTON
Practice Address - State:MI
Practice Address - Zip Code:48346-3533
Practice Address - Country:US
Practice Address - Phone:248-765-1376
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-17
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5201008129225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist