Healthcare Provider Details

I. General information

NPI: 1649421678
Provider Name (Legal Business Name): MONICA HOLDERBACH OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/08/2008
Last Update Date: 10/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5901 BROKEN SOUND PKWY STE 500
BOCA RATON FL
33487-2791
US

IV. Provider business mailing address

2926 SE PECK RD
TOPEKA KS
66605-1925
US

V. Phone/Fax

Practice location:
  • Phone: 561-367-1175
  • Fax: 561-417-7443
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: