Provider Demographics
NPI:1609228295
Name:PELLETIER, HOLLY
Entity Type:Individual
Prefix:
First Name:HOLLY
Middle Name:
Last Name:PELLETIER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 MONMOUTH ST
Mailing Address - Street 2:APT. 820
Mailing Address - City:BROOKLINE
Mailing Address - State:MA
Mailing Address - Zip Code:02446-5680
Mailing Address - Country:US
Mailing Address - Phone:207-752-6742
Mailing Address - Fax:
Practice Address - Street 1:101 MONMOUTH ST
Practice Address - Street 2:APT. 820
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02446-5680
Practice Address - Country:US
Practice Address - Phone:207-752-6742
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-07
Last Update Date:2016-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist