Provider Demographics
NPI:1023450483
Name:MATHIAS, HOLLY NICOLE (MS, OTR/L)
Entity type:Individual
Prefix:MRS
First Name:HOLLY
Middle Name:NICOLE
Last Name:MATHIAS
Suffix:
Gender:F
Credentials:MS, OTR/L
Other - Prefix:MS
Other - First Name:HOLLY
Other - Middle Name:NICOLE
Other - Last Name:MATTOX
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS,OTR/L
Mailing Address - Street 1:965 BELLBROOK RD
Mailing Address - Street 2:
Mailing Address - City:LOOGOOTEE
Mailing Address - State:IN
Mailing Address - Zip Code:47553-4613
Mailing Address - Country:US
Mailing Address - Phone:812-486-9425
Mailing Address - Fax:
Practice Address - Street 1:24 TEKE BURTON DRIVE
Practice Address - Street 2:
Practice Address - City:MITCHELL
Practice Address - State:IN
Practice Address - Zip Code:47446
Practice Address - Country:US
Practice Address - Phone:812-849-2221
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-25
Last Update Date:2013-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN31004794A225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist