Provider Demographics
NPI:1689874216
Name:HOLMES, COLLETTE ANGELLE (MOT, OTR/L)
Entity Type:Individual
Prefix:
First Name:COLLETTE
Middle Name:ANGELLE
Last Name:HOLMES
Suffix:
Gender:F
Credentials:MOT, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:759 E LINDEN AVE
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84102-2210
Mailing Address - Country:US
Mailing Address - Phone:415-425-3663
Mailing Address - Fax:
Practice Address - Street 1:759 E LINDEN AVE
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84102-2210
Practice Address - Country:US
Practice Address - Phone:415-425-3663
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-22
Last Update Date:2016-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UTOT 8903225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist