Provider Demographics
NPI:1790452282
Name:HOLESCHAK, CECELIA THIYEN
Entity Type:Individual
Prefix:
First Name:CECELIA
Middle Name:THIYEN
Last Name:HOLESCHAK
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 1:507 CHESTNUT LN # 507
Mailing Address - Street 2:
Mailing Address - City:WESTVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08093-1839
Mailing Address - Country:US
Mailing Address - Phone:609-774-2097
Mailing Address - Fax:
Practice Address - Street 1:214 S NEWTOWN STREET RD
Practice Address - Street 2:
Practice Address - City:NEWTOWN SQUARE
Practice Address - State:PA
Practice Address - Zip Code:19073-4000
Practice Address - Country:US
Practice Address - Phone:610-624-5111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-24
Last Update Date:2024-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PART0082762255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer