Provider Demographics
NPI:1881401172
Name:HOLLMAN, KAITLYN DANELLE (LMT)
Entity type:Individual
Prefix:MISS
First Name:KAITLYN
Middle Name:DANELLE
Last Name:HOLLMAN
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:MISS
Other - First Name:KAITLYN
Other - Middle Name:DANELLE
Other - Last Name:HOLLMAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:KAITLYN HOLLMAN
Mailing Address - Street 1:PO BOX 104
Mailing Address - Street 2:
Mailing Address - City:GUNNISON
Mailing Address - State:CO
Mailing Address - Zip Code:81230-0104
Mailing Address - Country:US
Mailing Address - Phone:970-779-0161
Mailing Address - Fax:
Practice Address - Street 1:329 BELLEVIEW AVE UNIT B
Practice Address - Street 2:
Practice Address - City:CRESTED BUTTE
Practice Address - State:CO
Practice Address - Zip Code:81224-8706
Practice Address - Country:US
Practice Address - Phone:970-779-0161
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-11
Last Update Date:2024-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COMT.0016384225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist