Provider Demographics
NPI:1124726641
Name:HOLBROOK, TERRY JOE
Entity type:Individual
Prefix:
First Name:TERRY
Middle Name:JOE
Last Name:HOLBROOK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5187 US ROUTE 60 STE 13
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25705-2076
Mailing Address - Country:US
Mailing Address - Phone:740-479-2481
Mailing Address - Fax:
Practice Address - Street 1:131 FLANNERY RD
Practice Address - Street 2:
Practice Address - City:BECKLEY
Practice Address - State:WV
Practice Address - Zip Code:25801-8099
Practice Address - Country:US
Practice Address - Phone:304-228-2771
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-23
Last Update Date:2023-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant