Provider Demographics
NPI:1831732932
Name:EAGER, HOLLY MICHELLE (COTA)
Entity type:Individual
Prefix:MS
First Name:HOLLY
Middle Name:MICHELLE
Last Name:EAGER
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6729 WHITE TAILED LN APT 2W
Mailing Address - Street 2:
Mailing Address - City:TINLEY PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60477-5094
Mailing Address - Country:US
Mailing Address - Phone:816-260-2361
Mailing Address - Fax:
Practice Address - Street 1:6320 159TH ST STE F
Practice Address - Street 2:
Practice Address - City:OAK FOREST
Practice Address - State:IL
Practice Address - Zip Code:60452-2780
Practice Address - Country:US
Practice Address - Phone:708-687-8768
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-21
Last Update Date:2019-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL057.005183224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant