Individual
HOLLY LOUISE BALTHAZOR
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
438 ASHFORD AVE, LOMIRA, WI 53048-9578
(920) 269-4386
Mailing address
1048 HOLLY TREE LN, FOND DU LAC, WI 54935-8008
(920) 960-1985
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
796-27
WI
Other
Enumeration date
10/24/2022
Last updated
10/24/2022
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