Provider Demographics
NPI:1609847300
Name:HOLLIDAY, JENNIFER MICHELLE (OTR L)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:MICHELLE
Last Name:HOLLIDAY
Suffix:
Gender:F
Credentials:OTR L
Other - Prefix:MS
Other - First Name:JENNIFER
Other - Middle Name:MICHELLE
Other - Last Name:MILLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR L
Mailing Address - Street 1:PO BOX 3457
Mailing Address - Street 2:
Mailing Address - City:CAREFREE
Mailing Address - State:AZ
Mailing Address - Zip Code:85377-3457
Mailing Address - Country:US
Mailing Address - Phone:480-595-2184
Mailing Address - Fax:480-595-0212
Practice Address - Street 1:17220 N BOSWELL BLVD
Practice Address - Street 2:SUITE L200
Practice Address - City:SUN CITY
Practice Address - State:AZ
Practice Address - Zip Code:85373-2000
Practice Address - Country:US
Practice Address - Phone:623-977-4911
Practice Address - Fax:623-977-4919
Is Sole Proprietor?:No
Enumeration Date:2006-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3071225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist