Provider Demographics
NPI:1730631722
Name:MCDONALD, HOLLY NICOLE (ATC)
Entity type:Individual
Prefix:
First Name:HOLLY
Middle Name:NICOLE
Last Name:MCDONALD
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1688 E 1275 S
Mailing Address - Street 2:
Mailing Address - City:KOKOMO
Mailing Address - State:IN
Mailing Address - Zip Code:46901-7620
Mailing Address - Country:US
Mailing Address - Phone:765-461-3261
Mailing Address - Fax:
Practice Address - Street 1:146 S MAIN ST
Practice Address - Street 2:APT. 103
Practice Address - City:ADRIAN
Practice Address - State:MI
Practice Address - Zip Code:49221-2606
Practice Address - Country:US
Practice Address - Phone:517-265-5161
Practice Address - Fax:517-264-3869
Is Sole Proprietor?:No
Enumeration Date:2016-10-26
Last Update Date:2016-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer