Provider Demographics
NPI:1780073999
Name:HOLZUM, SIERRA (OTR/L)
Entity type:Individual
Prefix:
First Name:SIERRA
Middle Name:
Last Name:HOLZUM
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:SIERRA
Other - Middle Name:
Other - Last Name:BAECHLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:617 WYATT CT
Mailing Address - Street 2:
Mailing Address - City:SAINT PETERS
Mailing Address - State:MO
Mailing Address - Zip Code:63376-7175
Mailing Address - Country:US
Mailing Address - Phone:314-210-4003
Mailing Address - Fax:
Practice Address - Street 1:617 WYATT CT
Practice Address - Street 2:
Practice Address - City:SAINT PETERS
Practice Address - State:MO
Practice Address - Zip Code:63376-7175
Practice Address - Country:US
Practice Address - Phone:314-210-4003
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-12
Last Update Date:2015-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIOT-1425225X00000X
MO2013027848225X00000X
TX116583225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist