Provider Demographics
NPI:1306326277
Name:SHORT, HOLLY (COMS)
Entity type:Individual
Prefix:
First Name:HOLLY
Middle Name:
Last Name:SHORT
Suffix:
Gender:F
Credentials:COMS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 YALE AVE
Mailing Address - Street 2:
Mailing Address - City:MORTON
Mailing Address - State:PA
Mailing Address - Zip Code:19070-1918
Mailing Address - Country:US
Mailing Address - Phone:610-938-9000
Mailing Address - Fax:
Practice Address - Street 1:941 SOUTH AVE APT A26
Practice Address - Street 2:
Practice Address - City:SECANE
Practice Address - State:PA
Practice Address - Zip Code:19018-3423
Practice Address - Country:US
Practice Address - Phone:717-514-3358
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-20
Last Update Date:2021-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
22364225CX0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225CX0006XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation CounselorOrientation and Mobility Training Provider