Provider Demographics
NPI:1154188514
Name:HOLTZCLAW, KAYLEY ERYN
Entity type:Individual
Prefix:
First Name:KAYLEY
Middle Name:ERYN
Last Name:HOLTZCLAW
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 1:13021 S 48TH ST APT 1053
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85044-4160
Mailing Address - Country:US
Mailing Address - Phone:423-732-2837
Mailing Address - Fax:
Practice Address - Street 1:13021 S 48TH ST APT 1053
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85044-4160
Practice Address - Country:US
Practice Address - Phone:423-732-2837
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-04
Last Update Date:2024-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer