Provider Demographics
NPI:1679646863
Name:HOLLOWAY, DEBRA L (OT)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:L
Last Name:HOLLOWAY
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:DEBRA
Other - Middle Name:L
Other - Last Name:RESSLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OT
Mailing Address - Street 1:790 REMINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-4909
Mailing Address - Country:US
Mailing Address - Phone:630-296-2223
Mailing Address - Fax:630-759-3251
Practice Address - Street 1:137 W HIGH ST STE 3
Practice Address - Street 2:
Practice Address - City:ELKTON
Practice Address - State:MD
Practice Address - Zip Code:21921-8600
Practice Address - Country:US
Practice Address - Phone:410-392-7027
Practice Address - Fax:410-392-5768
Is Sole Proprietor?:No
Enumeration Date:2006-11-16
Last Update Date:2016-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEU10000067225X00000X
MD06504225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0742831000OtherAMERIHEALTH/IBC
1679646863OtherCHAMPUS TRICARE
DE020242A78Medicare PIN