Basic Information
| Provider Information | |||||||||
| NPI: | 1710348032 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DICICCO | ||||||||
| FirstName: | HOLLY | ||||||||
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| Credential: | MOT, OTR/L | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2002 COLONY DR | ||||||||
| Address2: | |||||||||
| City: | ALIQUIPPA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 150019560 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4129656131 | ||||||||
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| Practice Location | |||||||||
| Address1: | 109 BLOSSOM LN | ||||||||
| Address2: | |||||||||
| City: | SALEM | ||||||||
| State: | OH | ||||||||
| PostalCode: | 444604284 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3303373033 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/14/2016 | ||||||||
| LastUpdateDate: | 03/14/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225XP0019X | OT 4676 | OH | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Physical Rehabilitation | 225XP0019X | OC006060L | PA | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Physical Rehabilitation |
No ID Information.