Provider Demographics
NPI:1285490730
Name:HOLLY, MEKAILA PEARL (MT-BC)
Entity type:Individual
Prefix:
First Name:MEKAILA
Middle Name:PEARL
Last Name:HOLLY
Suffix:
Gender:F
Credentials:MT-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1463 HILLCREST AVE APT 36
Mailing Address - Street 2:
Mailing Address - City:NILES
Mailing Address - State:OH
Mailing Address - Zip Code:44446-3757
Mailing Address - Country:US
Mailing Address - Phone:919-935-2928
Mailing Address - Fax:
Practice Address - Street 1:950 YOUNGSTOWN WARREN RD STE C
Practice Address - Street 2:
Practice Address - City:NILES
Practice Address - State:OH
Practice Address - Zip Code:44446-4626
Practice Address - Country:US
Practice Address - Phone:330-505-1606
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-22
Last Update Date:2024-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic TherapistGroup - Single Specialty