MEDICARE: KATHLEEN M HOLLABAUGH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	224Z00000X	Occupational Therapy Assistant	006877-1	NY

General Provider Information

NPI Number	:	1457501553
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHLEEN M HOLLABAUGH

Provider Business Mailing Address
First Line	:	4324 RIDGE RD
Second Line	:
City	:	ELBA
State	:	NY
Zip	:	14058-9763
Country	:	US
Telephone Number	:	585-757-9992
Fax Number	:

Provider Business Practice Location Address
First Line	:	4324 RIDGE RD
Second Line	:
City	:	ELBA
State	:	NY
Zip	:	14058-9763
Country	:	US
Telephone Number	:	585-757-9992
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/25/2008
Last Update Date	:	09/25/2008

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