Provider Demographics
NPI:1295384386
Name:HOLTHAUS, KATY MARIE (COTA/L)
Entity type:Individual
Prefix:
First Name:KATY
Middle Name:MARIE
Last Name:HOLTHAUS
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:KATY
Other - Middle Name:MARIE
Other - Last Name:WEIR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:COTA/L
Mailing Address - Street 1:7624 EXECUTIVE DR
Mailing Address - Street 2:
Mailing Address - City:EDEN PRAIRIE
Mailing Address - State:MN
Mailing Address - Zip Code:55344-3677
Mailing Address - Country:US
Mailing Address - Phone:952-944-0240
Mailing Address - Fax:
Practice Address - Street 1:7624 EXECUTIVE DR
Practice Address - Street 2:
Practice Address - City:EDEN PRAIRIE
Practice Address - State:MN
Practice Address - Zip Code:55344-3677
Practice Address - Country:US
Practice Address - Phone:952-944-0240
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-10
Last Update Date:2021-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN202465224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant