Provider Demographics
NPI:1659738839
Name:HOLLAND, D'ANDRE MONIQUE (OTD, OTR/L)
Entity Type:Individual
Prefix:
First Name:D'ANDRE
Middle Name:MONIQUE
Last Name:HOLLAND
Suffix:
Gender:F
Credentials:OTD, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6830 S VAN NESS AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90047-1654
Mailing Address - Country:US
Mailing Address - Phone:317-445-8573
Mailing Address - Fax:
Practice Address - Street 1:6830 S VAN NESS AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90047-1654
Practice Address - Country:US
Practice Address - Phone:317-445-8573
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-20
Last Update Date:2016-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13332225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA13332OtherCALIFORNIA BOARD OF OCCUPATIONAL THERAPY