=====================================================
General NPI Number Information
=====================================================
NPI Number | 1669324224
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MAKENNA LANIE HOLZ
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/13/2026
-----------------------------------------------------
Last Update Date | 02/13/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3326 E BADGER RD
-----------------------------------------------------
City | EVERSON
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98247-9232
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 360-988-4754
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5256 NOON RD
-----------------------------------------------------
City | BELLINGHAM
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98226-7904
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 360-393-5504
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225X00000X
-----------------------------------------------------
Taxonomy Name | Occupational Therapist
-----------------------------------------------------
License Number | OT70087137
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------