Provider Demographics
NPI:1609031095
Name:GOSSER, HOLLY (OT)
Entity Type:Individual
Prefix:
First Name:HOLLY
Middle Name:
Last Name:GOSSER
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:HOLLY
Other - Middle Name:D
Other - Last Name:JOHNS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OT
Mailing Address - Street 1:1211 W LIMA ST STE A
Mailing Address - Street 2:
Mailing Address - City:KENTON
Mailing Address - State:OH
Mailing Address - Zip Code:43326-8846
Mailing Address - Country:US
Mailing Address - Phone:419-674-2288
Mailing Address - Fax:
Practice Address - Street 1:1211 W LIMA ST STE A
Practice Address - Street 2:
Practice Address - City:KENTON
Practice Address - State:OH
Practice Address - Zip Code:43326-8846
Practice Address - Country:US
Practice Address - Phone:419-674-2288
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-24
Last Update Date:2014-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOT007125225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH4241431Medicare UPIN