Provider Demographics
NPI:1174760433
Name:ROUSSEAU, HOLLY ANN (OTR/L)
Entity type:Individual
Prefix:MRS
First Name:HOLLY
Middle Name:ANN
Last Name:ROUSSEAU
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:420 64 STREET
Mailing Address - Street 2:APARTMENT 8H
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11220
Mailing Address - Country:US
Mailing Address - Phone:917-660-1909
Mailing Address - Fax:
Practice Address - Street 1:420 64TH ST
Practice Address - Street 2:APARTMENT 8H
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11220-4900
Practice Address - Country:US
Practice Address - Phone:917-660-1909
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-08
Last Update Date:2009-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008409225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics