Provider Demographics
NPI:1083439780
Name:PATTERSON, HOLLY MARIE
Entity type:Individual
Prefix:
First Name:HOLLY
Middle Name:MARIE
Last Name:PATTERSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:49 N TOWNSHIP ROAD 15
Mailing Address - Street 2:
Mailing Address - City:TIFFIN
Mailing Address - State:OH
Mailing Address - Zip Code:44883-8777
Mailing Address - Country:US
Mailing Address - Phone:567-230-6626
Mailing Address - Fax:
Practice Address - Street 1:410 FAIR LN
Practice Address - Street 2:
Practice Address - City:TIFFIN
Practice Address - State:OH
Practice Address - Zip Code:44883-2518
Practice Address - Country:US
Practice Address - Phone:567-230-6626
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-18
Last Update Date:2024-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH06075224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant