Provider Demographics
NPI:1821233263
Name:HOLT, SALLY L (PHD)
Entity Type:Individual
Prefix:DR
First Name:SALLY
Middle Name:L
Last Name:HOLT
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2800 HAYES AVE
Mailing Address - Street 2:BUILDING A
Mailing Address - City:SANDUSKY
Mailing Address - State:OH
Mailing Address - Zip Code:44870-7248
Mailing Address - Country:US
Mailing Address - Phone:419-626-6161
Mailing Address - Fax:419-626-7030
Practice Address - Street 1:2819 HAYES AVE
Practice Address - Street 2:SUITE 8
Practice Address - City:SANDUSKY
Practice Address - State:OH
Practice Address - Zip Code:44870-5391
Practice Address - Country:US
Practice Address - Phone:419-621-0158
Practice Address - Fax:419-621-0405
Is Sole Proprietor?:No
Enumeration Date:2008-12-15
Last Update Date:2009-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHA-00265237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHA-00265OtherOHIO LICENSE