Provider Demographics
NPI:1932308798
Name:HOLZBAUER, NICOLE L (OTR/L)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:L
Last Name:HOLZBAUER
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:PO BOX 1284
Mailing Address - Street 2:501 WEST HAVENS SUITE 103
Mailing Address - City:MITCHELL
Mailing Address - State:SD
Mailing Address - Zip Code:57301-7284
Mailing Address - Country:US
Mailing Address - Phone:605-995-6044
Mailing Address - Fax:605-995-6044
Practice Address - Street 1:501 W HAVENS AVE
Practice Address - Street 2:SUITE 103
Practice Address - City:MITCHELL
Practice Address - State:SD
Practice Address - Zip Code:57301-4334
Practice Address - Country:US
Practice Address - Phone:605-995-6044
Practice Address - Fax:605-995-6044
Is Sole Proprietor?:No
Enumeration Date:2007-07-12
Last Update Date:2007-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD0668225X00000X
NE1247225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist