Provider Demographics
NPI:1831217470
Name:HOLLAND, HEIDI MARIE (OT)
Entity type:Individual
Prefix:MRS
First Name:HEIDI
Middle Name:MARIE
Last Name:HOLLAND
Suffix:
Gender:F
Credentials:OT
Other - Prefix:MS
Other - First Name:HEIDI
Other - Middle Name:MARIE
Other - Last Name:POWELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OT
Mailing Address - Street 1:3627 CLEARVIEW DR
Mailing Address - Street 2:
Mailing Address - City:HERMITAGE
Mailing Address - State:PA
Mailing Address - Zip Code:16148
Mailing Address - Country:US
Mailing Address - Phone:724-982-0970
Mailing Address - Fax:724-982-0870
Practice Address - Street 1:3023 WILMINGTON RD
Practice Address - Street 2:PEDIATRIC THERAPY PROFESSIONALS
Practice Address - City:NEW CASTLE
Practice Address - State:PA
Practice Address - Zip Code:16105
Practice Address - Country:US
Practice Address - Phone:724-656-8814
Practice Address - Fax:724-656-8815
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOL005927L225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1017856670001OtherMEDICAL ASSISTANCE NUMBER