Provider Demographics
NPI:1659044600
Name:PERSINGER, HOLLY RUTH (MOTR/L)
Entity Type:Individual
Prefix:
First Name:HOLLY
Middle Name:RUTH
Last Name:PERSINGER
Suffix:
Gender:F
Credentials:MOTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19395 W CAPITOL DR STE 200
Mailing Address - Street 2:
Mailing Address - City:BROOKFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53045-2736
Mailing Address - Country:US
Mailing Address - Phone:262-923-7101
Mailing Address - Fax:262-923-7178
Practice Address - Street 1:3821 KOHLER MEMORIAL DR STE 102
Practice Address - Street 2:
Practice Address - City:SHEBOYGAN
Practice Address - State:WI
Practice Address - Zip Code:53081-3600
Practice Address - Country:US
Practice Address - Phone:920-208-9648
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-27
Last Update Date:2023-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI7046-26225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL907401090OtherUNITEDHEALTHCARE