Provider Demographics
NPI:1902526189
Name:ROSS-HOLLAND, JOHAN S (OTR)
Entity Type:Individual
Prefix:
First Name:JOHAN
Middle Name:S
Last Name:ROSS-HOLLAND
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40233 WYNGATE CT
Mailing Address - Street 2:
Mailing Address - City:PALMDALE
Mailing Address - State:CA
Mailing Address - Zip Code:93551-7538
Mailing Address - Country:US
Mailing Address - Phone:166-199-2626
Mailing Address - Fax:
Practice Address - Street 1:40233 WYNGATE CT
Practice Address - Street 2:
Practice Address - City:PALMDALE
Practice Address - State:CA
Practice Address - Zip Code:93551-7538
Practice Address - Country:US
Practice Address - Phone:166-199-2626
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-30
Last Update Date:2022-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA23192225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist