Provider Demographics
NPI:1891886891
Name:HOLLIDAY, JOYCE (OTR)
Entity Type:Individual
Prefix:
First Name:JOYCE
Middle Name:
Last Name:HOLLIDAY
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:JOYCE
Other - Middle Name:
Other - Last Name:FRIEDLAND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:38797 COUNTY ROAD 14
Mailing Address - Street 2:
Mailing Address - City:BIGFORK
Mailing Address - State:MN
Mailing Address - Zip Code:56628-4663
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1402 HIGHWAY 71
Practice Address - Street 2:
Practice Address - City:INTERNATIONAL FALLS
Practice Address - State:MN
Practice Address - Zip Code:56649-2154
Practice Address - Country:US
Practice Address - Phone:763-689-5385
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN101081225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN6405415OtherMEDICA
MN5G702HOOtherBCBS
MNHP49612OtherHEALTH PARTNERS
MN5G702HOOtherBCBS