1225609795 NPI number — HOLLY M ROSS BS/MOT/OTRL/WSI

Table of content: HOLLY M ROSS BS/MOT/OTRL/WSI (NPI 1225609795)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225609795 NPI number — HOLLY M ROSS BS/MOT/OTRL/WSI

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ROSS
Provider First Name:
HOLLY
Provider Middle Name:
M
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
BS/MOT/OTRL/WSI
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1225609795
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/06/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
40 W LITTLETON BLVD STE 210-105
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LITTLETON
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80120-2478
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
720-610-9928
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
40 W LITTLETON BLVD
Provider Second Line Business Practice Location Address:
SUITE 210-105
Provider Business Practice Location Address City Name:
LITTLETON
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80120
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
720-610-9928
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/06/2021

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225XP0200X , with the licence number:  OT.0005668 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225X00000X , with the licence number: OT.0005668 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 225XF0002X , with the licence number: OT.0005668 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 40862 . This is a "NBCOT LICENSE NUMBER" identifier . This identifiers is of the category "OTHER".
  • Identifier: 5201010613 . This is a "MICHIGAN STATE LICENSE" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: OT.0005668 . This is a "COLORADO STATE LICENSE NUMBER" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".