Provider Demographics
NPI:1982817029
Name:ANDERSON, HOLLY LYNN (COTA)
Entity Type:Individual
Prefix:
First Name:HOLLY
Middle Name:LYNN
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:244 GREEN TREE DR
Mailing Address - Street 2:
Mailing Address - City:BELGRADE
Mailing Address - State:MT
Mailing Address - Zip Code:59714-9519
Mailing Address - Country:US
Mailing Address - Phone:406-939-0793
Mailing Address - Fax:
Practice Address - Street 1:612 E MAIN ST
Practice Address - Street 2:SUITE C
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59715-3719
Practice Address - Country:US
Practice Address - Phone:406-522-3722
Practice Address - Fax:406-522-0018
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT982224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant