Provider Demographics
NPI:1801890330
Name:DIETZ, HOLLY CHESNEY (OC)
Entity type:Individual
Prefix:
First Name:HOLLY
Middle Name:CHESNEY
Last Name:DIETZ
Suffix:
Gender:F
Credentials:OC
Other - Prefix:
Other - First Name:HOLLY
Other - Middle Name:
Other - Last Name:CHESNEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:421 S BEST AVE
Mailing Address - Street 2:
Mailing Address - City:WALNUTPORT
Mailing Address - State:PA
Mailing Address - Zip Code:18088-1217
Mailing Address - Country:US
Mailing Address - Phone:610-760-1520
Mailing Address - Fax:610-760-1721
Practice Address - Street 1:451 SAND HILL RD
Practice Address - Street 2:
Practice Address - City:HERSHEY
Practice Address - State:PA
Practice Address - Zip Code:17033-3411
Practice Address - Country:US
Practice Address - Phone:717-533-2946
Practice Address - Fax:717-312-1671
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC001197L225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA394529Medicare ID - Type Unspecified