Provider Demographics
NPI:1104236116
Name:HOLGATE, JACQUELINE KAY (OTR/L)
Entity type:Individual
Prefix:MRS
First Name:JACQUELINE
Middle Name:KAY
Last Name:HOLGATE
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 1:1705 COUNTRY CLUB DR
Mailing Address - Street 2:
Mailing Address - City:ELK POINT
Mailing Address - State:SD
Mailing Address - Zip Code:57025-2325
Mailing Address - Country:US
Mailing Address - Phone:507-848-0436
Mailing Address - Fax:
Practice Address - Street 1:600 S FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:ELK POINT
Practice Address - State:SD
Practice Address - Zip Code:57025
Practice Address - Country:US
Practice Address - Phone:605-356-3894
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-29
Last Update Date:2014-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD0916225X00000X
IA002428225X00000X
NE1798225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist