Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0200X | Occupational Therapist - Pediatrics | OT.0005125 | CO |
NPI | 1043729148 |
---|---|
Provider Name | Courtney Lynn Holen |
First Address | Colorado Springs, CO 80920-3288 |
Second Address | Colorado Springs, CO 80906-7372 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/09/2017 |
Last Update Date | 14/01/2022 |