Healthcare Provider Details

I. General information

NPI: 1235462094
Provider Name (Legal Business Name): HOLLY M GUTIERREZ MS, OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/11/2009
Last Update Date: 01/23/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1545 W US HIGHWAY 30
SCHERERVILLE IN
46375
US

IV. Provider business mailing address

1545 W US HIGHWAY 30
SCHERERVILLE IN
46375-1562
US

V. Phone/Fax

Practice location:
  • Phone: 219-836-5381
  • Fax:
Mailing address:
  • Phone: 219-836-5381
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number4765-026
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code225XH1200X
TaxonomyHand Occupational Therapist
License Number31004979A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: