Provider Demographics
NPI:1780187492
Name:HOLLO, KILLIAN MARK
Entity Type:Individual
Prefix:
First Name:KILLIAN
Middle Name:MARK
Last Name:HOLLO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3320 LOCUST ST APT 812
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63103-1129
Mailing Address - Country:US
Mailing Address - Phone:440-376-1166
Mailing Address - Fax:
Practice Address - Street 1:3320 LOCUST ST APT 812
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63103-1129
Practice Address - Country:US
Practice Address - Phone:440-376-1166
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-09
Last Update Date:2018-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic TrainerGroup - Single Specialty