Provider Demographics
NPI:1386704294
Name:MINER, HOLLI (OT)
Entity type:Individual
Prefix:
First Name:HOLLI
Middle Name:
Last Name:MINER
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4824 ENCHANTED PINES DR
Mailing Address - Street 2:
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57701-9235
Mailing Address - Country:US
Mailing Address - Phone:605-484-9759
Mailing Address - Fax:605-721-5940
Practice Address - Street 1:4824 ENCHANTED PINES DR
Practice Address - Street 2:
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57701-9235
Practice Address - Country:US
Practice Address - Phone:605-484-9759
Practice Address - Fax:605-721-5940
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD0597225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist