Provider Demographics
NPI:1366901399
Name:IVES, HOLLY MAE
Entity type:Individual
Prefix:
First Name:HOLLY
Middle Name:MAE
Last Name:IVES
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 1:2435 SE TECUMSEH RD
Mailing Address - Street 2:
Mailing Address - City:TECUMSEH
Mailing Address - State:KS
Mailing Address - Zip Code:66542-9327
Mailing Address - Country:US
Mailing Address - Phone:785-806-5556
Mailing Address - Fax:
Practice Address - Street 1:509 UNIVERSITY DRIVE
Practice Address - Street 2:
Practice Address - City:EAU CLAIRE
Practice Address - State:WI
Practice Address - Zip Code:54701-5470
Practice Address - Country:US
Practice Address - Phone:785-806-5556
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-19
Last Update Date:2019-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer