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General NPI Number Information
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NPI Number | 1326294406
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Entity Type | Individual
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Provider Name | DEIDRA S HOLLAND MSOT, ED.D.
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Gender | Female
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Dates
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Enumeration Date | 08/08/2008
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Last Update Date | 07/07/2013
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Provider Practice Location Address
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Address Line | 360 COLBORNE ST SPPS ADMIN
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City | SAINT PAUL
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State | MN
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Zip | 55102-3228
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Country | US
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Telephone | 952-956-2467
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Fax |
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Provider Business Mailing Address
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Address Line | 4817 DUNBERRY LN
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City | EDINA
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State | MN
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Zip | 55435-1536
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Country | US
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Telephone | 952-956-2467
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 103636
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 225XP0200X
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Taxonomy Name | Pediatric Occupational Therapist
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License Number | 103636
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License Number State | MN
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