Provider Demographics
NPI:1023422508
Name:ZIMMERMAN, HOLLY ANN
Entity type:Individual
Prefix:
First Name:HOLLY
Middle Name:ANN
Last Name:ZIMMERMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:HOLLY
Other - Middle Name:ANN
Other - Last Name:MARTZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:114 W MYRTLEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:NEWBERG
Mailing Address - State:OR
Mailing Address - Zip Code:97132-9282
Mailing Address - Country:US
Mailing Address - Phone:503-753-2908
Mailing Address - Fax:
Practice Address - Street 1:9375 SW COMMERCE CIR STE A1
Practice Address - Street 2:
Practice Address - City:WILSONVILLE
Practice Address - State:OR
Practice Address - Zip Code:97070-9630
Practice Address - Country:US
Practice Address - Phone:503-582-9200
Practice Address - Fax:503-582-1487
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-12
Last Update Date:2025-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR20652225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist