Healthcare Provider Details

I. General information

NPI: 1275454670
Provider Name (Legal Business Name): MICHAEL B HOLLEY
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/22/2026
Last Update Date: 08/02/2026
Certification Date: 08/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

46 HIGH ST
FREDERICKTOWN OH
43019-1017
US

IV. Provider business mailing address

46 HIGH ST
FREDERICKTOWN OH
43019-1017
US

V. Phone/Fax

Practice location:
  • Phone: 614-403-3882
  • Fax:
Mailing address:
  • Phone: 614-403-3882
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code146L00000X
TaxonomyParamedic
License Number132626
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: