Provider Demographics
NPI:1851736276
Name:BRONSON, HOLLYE A (OTRL)
Entity Type:Individual
Prefix:MS
First Name:HOLLYE
Middle Name:A
Last Name:BRONSON
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1459 JEMEZ LOOP NE
Mailing Address - Street 2:
Mailing Address - City:RIO RANCHO
Mailing Address - State:NM
Mailing Address - Zip Code:87144-5355
Mailing Address - Country:US
Mailing Address - Phone:505-263-2225
Mailing Address - Fax:
Practice Address - Street 1:1459 JEMEZ LOOP NE
Practice Address - Street 2:
Practice Address - City:RIO RANCHO
Practice Address - State:NM
Practice Address - Zip Code:87144-5355
Practice Address - Country:US
Practice Address - Phone:505-263-2225
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-30
Last Update Date:2013-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM1795225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist