Provider Demographics
NPI:1689120602
Name:HOLLIDAY, KOREY
Entity Type:Individual
Prefix:
First Name:KOREY
Middle Name:
Last Name:HOLLIDAY
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 1:4836 STATE ROUTE 325
Mailing Address - Street 2:
Mailing Address - City:PATRIOT
Mailing Address - State:OH
Mailing Address - Zip Code:45658-8960
Mailing Address - Country:US
Mailing Address - Phone:740-379-9085
Mailing Address - Fax:
Practice Address - Street 1:4834 STATE ROUTE 325
Practice Address - Street 2:SOUTHWESTERN ELEMENTARY
Practice Address - City:PATRIOT
Practice Address - State:OH
Practice Address - Zip Code:45658-8960
Practice Address - Country:US
Practice Address - Phone:740-379-2532
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-30
Last Update Date:2016-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP.11338235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist