Provider Demographics
NPI:1972802874
Name:HOLGATE, KELLY (OTR)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:HOLGATE
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7770 E ILIFF AVE
Mailing Address - Street 2:SUITE C
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80231-7010
Mailing Address - Country:US
Mailing Address - Phone:303-333-8360
Mailing Address - Fax:303-333-8380
Practice Address - Street 1:7770 E ILIFF AVE
Practice Address - Street 2:SUITE C
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80231-7010
Practice Address - Country:US
Practice Address - Phone:303-333-8360
Practice Address - Fax:303-333-8380
Is Sole Proprietor?:No
Enumeration Date:2011-03-18
Last Update Date:2013-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO3151225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics