Provider Demographics
NPI:1609074368
Name:HOLTZCLAW, SANDRA DEAN (OTR)
Entity Type:Individual
Prefix:MS
First Name:SANDRA
Middle Name:DEAN
Last Name:HOLTZCLAW
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 SHALLOTTE CROSSING PKWY STE 5
Mailing Address - Street 2:#202
Mailing Address - City:SHALLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28470-8118
Mailing Address - Country:US
Mailing Address - Phone:336-491-5022
Mailing Address - Fax:
Practice Address - Street 1:120 SHALLOTTE CROSSING PKWY
Practice Address - Street 2:SUITE #5 BOX 202
Practice Address - City:SHALLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28470-8117
Practice Address - Country:US
Practice Address - Phone:336-491-5022
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR970633225X00000X
NC2066225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist