Provider Demographics
NPI:1134871247
Name:HOLSINGER, DEREK JAMES
Entity type:Individual
Prefix:
First Name:DEREK
Middle Name:JAMES
Last Name:HOLSINGER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:231 LOCUST DR
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27858-1759
Mailing Address - Country:US
Mailing Address - Phone:919-223-4266
Mailing Address - Fax:
Practice Address - Street 1:312 WARREN AVE
Practice Address - Street 2:
Practice Address - City:KINSTON
Practice Address - State:NC
Practice Address - Zip Code:28501-3840
Practice Address - Country:US
Practice Address - Phone:252-523-0082
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-20
Last Update Date:2022-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy AssistantGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC000039892061OtherLICENSE ID NUMBER