Provider Demographics
NPI:1740460385
Name:HOLT, KIMBERLY SUZANNE (OTR)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:SUZANNE
Last Name:HOLT
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 SPANISH TRCE
Mailing Address - Street 2:
Mailing Address - City:SILSBEE
Mailing Address - State:TX
Mailing Address - Zip Code:77656-8928
Mailing Address - Country:US
Mailing Address - Phone:409-722-5437
Mailing Address - Fax:409-722-5435
Practice Address - Street 1:8700 9TH AVE
Practice Address - Street 2:SUITE 103
Practice Address - City:PORT ARTHUR
Practice Address - State:TX
Practice Address - Zip Code:77642-8030
Practice Address - Country:US
Practice Address - Phone:409-722-5437
Practice Address - Fax:409-722-5435
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-12
Last Update Date:2007-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX110218OtherEXECUTIVE COUNCIL OT