Provider Demographics
NPI:1720749567
Name:HOLLAN, KERSTIN MARIE
Entity Type:Individual
Prefix:
First Name:KERSTIN
Middle Name:MARIE
Last Name:HOLLAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4003 VICENZA AVE
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77493-2877
Mailing Address - Country:US
Mailing Address - Phone:713-417-1602
Mailing Address - Fax:
Practice Address - Street 1:17200 STATE HIGHWAY 249 STE 150
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77064-1319
Practice Address - Country:US
Practice Address - Phone:281-664-6900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-04
Last Update Date:2022-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX122078225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX122078OtherTBOTE LICENSE
TX35056225OtherTEXAS DRIVER'S LICENSE