Provider Demographics
NPI:1154920866
Name:NELSON, HOLLY (OTR/L)
Entity type:Individual
Prefix:
First Name:HOLLY
Middle Name:
Last Name:NELSON
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 1:4910 FORGE HAVEN DR
Mailing Address - Street 2:
Mailing Address - City:PERRY HALL
Mailing Address - State:MD
Mailing Address - Zip Code:21128-9759
Mailing Address - Country:US
Mailing Address - Phone:410-967-9893
Mailing Address - Fax:
Practice Address - Street 1:4910 FORGE HAVEN DR
Practice Address - Street 2:
Practice Address - City:PERRY HALL
Practice Address - State:MD
Practice Address - Zip Code:21128-9759
Practice Address - Country:US
Practice Address - Phone:410-882-1345
Practice Address - Fax:410-882-1345
Is Sole Proprietor?:No
Enumeration Date:2020-10-22
Last Update Date:2020-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD03646225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist