Provider Demographics
NPI:1962408567
Name:HOLDER, KATHERINE LYNN (OTR/L)
Entity type:Individual
Prefix:MS
First Name:KATHERINE
Middle Name:LYNN
Last Name:HOLDER
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 1:2546 E 2ND ST
Mailing Address - Street 2:BLDG 500
Mailing Address - City:CASPER
Mailing Address - State:WY
Mailing Address - Zip Code:82609-2047
Mailing Address - Country:US
Mailing Address - Phone:307-577-5204
Mailing Address - Fax:307-577-5212
Practice Address - Street 1:2546 E 2ND ST
Practice Address - Street 2:BLDG 500
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82609-2047
Practice Address - Country:US
Practice Address - Phone:307-577-5204
Practice Address - Fax:307-577-5212
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-28
Last Update Date:2007-07-08
Deactivation Date:2006-03-17
Deactivation Code:
Reactivation Date:2006-04-05
Provider Licenses
StateLicense IDTaxonomies
WYCOTA-534224Z00000X
WYCOTA-589224Z00000X
WYPT-891225100000X
WYPTA-490225200000X
WYOTR-452225X00000X
WYOT-031225X00000X
WYSP-395235Z00000X
WYSP-169235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant
Not Answered225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Not Answered225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Not Answered225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Not Answered235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY00693001OtherBLUE CROSS BLUE SHIELD
WY00693001OtherBLUE CROSS BLUE SHIELD