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NPI Code Detail

MEDICARE: LISA CREECH HOLT

MEDICARE: LISA CREECH HOLT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1224Z00000XOccupational Therapy Assistant5202007718MI
2224Z00000XOccupational Therapy Assistant311880

General Provider Information

NPI Number : 1821951765
Entity Type Code : Individual
Provider Name (Legal Business Name) : LISA CREECH HOLT
Provider Business Mailing Address
First Line : 200 GLENHAVEN AVE NW
Second Line :
City : GRAND RAPIDS
State : MI
Zip : 49504-4932
Country : US
Telephone Number : 616-301-4426
Fax Number :
Provider Business Practice Location Address
First Line : 3400 WILSON AVE SW
Second Line :
City : GRANDVILLE
State : MI
Zip : 49418-1854
Country : US
Telephone Number : 616-534-5487
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/08/2025
Last Update Date : 12/08/2025

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Directions to “ LISA CREECH HOLT ” Practice Location

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