Provider Demographics
NPI:1578863882
Name:MAGILL, HOLLY (OTR/L)
Entity type:Individual
Prefix:
First Name:HOLLY
Middle Name:
Last Name:MAGILL
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:847 MEADOWBROOK RD
Mailing Address - Street 2:
Mailing Address - City:TRAFFORD
Mailing Address - State:PA
Mailing Address - Zip Code:15085-2822
Mailing Address - Country:US
Mailing Address - Phone:412-646-4734
Mailing Address - Fax:
Practice Address - Street 1:847 MEADOWBROOK RD
Practice Address - Street 2:
Practice Address - City:TRAFFORD
Practice Address - State:PA
Practice Address - Zip Code:15085-2822
Practice Address - Country:US
Practice Address - Phone:412-646-4734
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-02
Last Update Date:2010-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC006595L171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor