Provider Demographics
NPI:1487334447
Name:DOUGLAS, HOLLY LYNN (CTRS)
Entity type:Individual
Prefix:
First Name:HOLLY
Middle Name:LYNN
Last Name:DOUGLAS
Suffix:
Gender:F
Credentials:CTRS
Other - Prefix:
Other - First Name:HOLLY
Other - Middle Name:L
Other - Last Name:DELEON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7711 E ML AVE
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49048-8553
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7711 E ML AVE
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49048-8553
Practice Address - Country:US
Practice Address - Phone:269-552-8442
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-24
Last Update Date:2023-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRecreation Therapist