Provider Demographics
NPI:1942995485
Name:HOLLEY, KAITLYN MCKINLEY (OTD, OTR/L)
Entity type:Individual
Prefix:
First Name:KAITLYN
Middle Name:MCKINLEY
Last Name:HOLLEY
Suffix:
Gender:F
Credentials:OTD, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 GRANGE HALL DR APT 5301
Mailing Address - Street 2:
Mailing Address - City:EULESS
Mailing Address - State:TX
Mailing Address - Zip Code:76039-2265
Mailing Address - Country:US
Mailing Address - Phone:970-481-3434
Mailing Address - Fax:
Practice Address - Street 1:816 KELLER PKWY STE B302
Practice Address - Street 2:
Practice Address - City:KELLER
Practice Address - State:TX
Practice Address - Zip Code:76248-2479
Practice Address - Country:US
Practice Address - Phone:817-562-8731
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-10
Last Update Date:2023-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX123503225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist