Provider Demographics
NPI:1851416531
Name:THORUP, HOLLY RONEL (OTR/L)
Entity Type:Individual
Prefix:
First Name:HOLLY
Middle Name:RONEL
Last Name:THORUP
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6076 S 900 E
Mailing Address - Street 2:SUITE 151
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84121-1761
Mailing Address - Country:US
Mailing Address - Phone:801-639-0020
Mailing Address - Fax:
Practice Address - Street 1:6076 S 900 E
Practice Address - Street 2:SUITE 151
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84121-1761
Practice Address - Country:US
Practice Address - Phone:801-639-0020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2014-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT373343-4201225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist