Provider Demographics
NPI:1881713048
Name:MIRE, HOLLY B (OT)
Entity type:Individual
Prefix:MRS
First Name:HOLLY
Middle Name:B
Last Name:MIRE
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1331 LAGNEAUX RD
Mailing Address - Street 2:
Mailing Address - City:DUSON
Mailing Address - State:LA
Mailing Address - Zip Code:70529-4400
Mailing Address - Country:US
Mailing Address - Phone:337-988-6948
Mailing Address - Fax:
Practice Address - Street 1:1331 LAGNEAUX RD
Practice Address - Street 2:
Practice Address - City:DUSON
Practice Address - State:LA
Practice Address - Zip Code:70529-4400
Practice Address - Country:US
Practice Address - Phone:337-230-9929
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-28
Last Update Date:2022-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAOTT.Z11991225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist