Provider Demographics
NPI:1336257799
Name:COUCH, HOLLY L (OTR/L)
Entity Type:Individual
Prefix:
First Name:HOLLY
Middle Name:L
Last Name:COUCH
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4806 TIMBER COMMONS DR
Mailing Address - Street 2:SUITE B
Mailing Address - City:SANDUSKY
Mailing Address - State:OH
Mailing Address - Zip Code:44870-7161
Mailing Address - Country:US
Mailing Address - Phone:419-621-1166
Mailing Address - Fax:419-627-4263
Practice Address - Street 1:4806 TIMBER COMMONS DR
Practice Address - Street 2:SUITE B
Practice Address - City:SANDUSKY
Practice Address - State:OH
Practice Address - Zip Code:44870-7161
Practice Address - Country:US
Practice Address - Phone:419-621-1166
Practice Address - Fax:419-627-4263
Is Sole Proprietor?:No
Enumeration Date:2006-08-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOT-004512225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist