Provider Demographics
NPI:1780060293
Name:HOLCK, DEANNA (OTR)
Entity type:Individual
Prefix:
First Name:DEANNA
Middle Name:
Last Name:HOLCK
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 1:1030 CRESTLANE DR
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48601-9307
Mailing Address - Country:US
Mailing Address - Phone:989-321-0632
Mailing Address - Fax:
Practice Address - Street 1:1030 CRESTLANE DR
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48601-9307
Practice Address - Country:US
Practice Address - Phone:989-321-0632
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-06
Last Update Date:2015-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5201006196225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist