Provider Demographics
NPI:1730509571
Name:BAUERLEIN, HOLLY BETH (OTR)
Entity type:Individual
Prefix:
First Name:HOLLY
Middle Name:BETH
Last Name:BAUERLEIN
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 1:1003 SHADOW CIR
Mailing Address - Street 2:
Mailing Address - City:LEAGUE CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77573-3631
Mailing Address - Country:US
Mailing Address - Phone:713-962-6994
Mailing Address - Fax:
Practice Address - Street 1:1003 SHADOW CIR
Practice Address - Street 2:
Practice Address - City:LEAGUE CITY
Practice Address - State:TX
Practice Address - Zip Code:77573-3631
Practice Address - Country:US
Practice Address - Phone:713-962-6994
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-20
Last Update Date:2014-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX100173225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics