Provider Demographics
NPI:1942409412
Name:HOLBROOK, RYAN MITCHELL (OTR)
Entity Type:Individual
Prefix:MR
First Name:RYAN
Middle Name:MITCHELL
Last Name:HOLBROOK
Suffix:
Gender:M
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:571 PARKWAY DR
Mailing Address - Street 2:
Mailing Address - City:SALYERSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:41465-9248
Mailing Address - Country:US
Mailing Address - Phone:606-349-6182
Mailing Address - Fax:606-349-5962
Practice Address - Street 1:571 PARKWAY DR
Practice Address - Street 2:
Practice Address - City:SALYERSVILLE
Practice Address - State:KY
Practice Address - Zip Code:41465-9248
Practice Address - Country:US
Practice Address - Phone:606-349-6182
Practice Address - Fax:606-349-5962
Is Sole Proprietor?:No
Enumeration Date:2007-07-16
Last Update Date:2007-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYTEMPORAY225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist