Healthcare Provider Details

I. General information

NPI: 1003432915
Provider Name (Legal Business Name): HOLLY GUENTHER OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2020
Last Update Date: 04/28/2024
Certification Date: 04/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3439 HOBSON RD
FORT WAYNE IN
46805-1617
US

IV. Provider business mailing address

14194 ESCONDIDA CV
FORT WAYNE IN
46845-0171
US

V. Phone/Fax

Practice location:
  • Phone: 260-373-7925
  • Fax:
Mailing address:
  • Phone: 260-466-7565
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number31006364A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: