Provider Demographics
NPI:1861225393
Name:HOLDER, RYAN MADISON (OTD, OTR/L)
Entity type:Individual
Prefix:
First Name:RYAN
Middle Name:MADISON
Last Name:HOLDER
Suffix:
Gender:F
Credentials:OTD, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:520 LEW DEWITT BLVD STE 201
Mailing Address - Street 2:
Mailing Address - City:WAYNESBORO
Mailing Address - State:VA
Mailing Address - Zip Code:22980-1644
Mailing Address - Country:US
Mailing Address - Phone:540-451-2021
Mailing Address - Fax:
Practice Address - Street 1:520 LEW DEWITT BLVD STE 201
Practice Address - Street 2:
Practice Address - City:WAYNESBORO
Practice Address - State:VA
Practice Address - Zip Code:22980-1644
Practice Address - Country:US
Practice Address - Phone:540-451-2021
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-21
Last Update Date:2024-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0119010600225XP0200X, 225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics