Provider Demographics
NPI:1609017748
Name:HOLLAND, DIANNE SUE BUMPAS (OTR/L)
Entity Type:Individual
Prefix:
First Name:DIANNE
Middle Name:SUE BUMPAS
Last Name:HOLLAND
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 1:2500 ROCKY MOUNTAIN AVE
Mailing Address - Street 2:NORTH MOB
Mailing Address - City:LOVELAND
Mailing Address - State:CO
Mailing Address - Zip Code:80538-9004
Mailing Address - Country:US
Mailing Address - Phone:970-495-8450
Mailing Address - Fax:970-624-3392
Practice Address - Street 1:2500 ROCKY MOUNTAIN AVE
Practice Address - Street 2:NORTH MOB
Practice Address - City:LOVELAND
Practice Address - State:CO
Practice Address - Zip Code:80538-9004
Practice Address - Country:US
Practice Address - Phone:970-495-8450
Practice Address - Fax:970-624-3392
Is Sole Proprietor?:No
Enumeration Date:2009-03-19
Last Update Date:2016-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COOT-1061225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist