Active NPI
Laura Ann Holobaugh, OTR/L
- Occupational Therapist
- Belleville, IL
National Provider Identifier
1174873483
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- 056006672
- Practice address
- 4700 Memorial Dr
Suite 150
Belleville, IL 62226-5373 - Phone
- (618) 257-5250
- NPI assigned
- Sep 13, 2012
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Occupational Therapist | 225X00000X | 056006672 | IL | Primary |
Addresses
Primary practice location
4700 Memorial Dr
Suite 150
Belleville, IL 62226-5373
Mailing address
4700 Memorial Dr
Suite 150
Belleville, IL 62226-5373
Phone (618) 257-5250
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 056006672 | IL | MD | Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1347494400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1347494400000",
"number": "1174873483",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4700 MEMORIAL DR",
"address_2": "SUITE 150",
"city": "BELLEVILLE",
"state": "IL",
"postal_code": "622265373",
"telephone_number": "618-257-5250"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4700 MEMORIAL DR",
"address_2": "SUITE 150",
"city": "BELLEVILLE",
"state": "IL",
"postal_code": "622265373",
"telephone_number": "618-257-5250"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HOLOBAUGH",
"first_name": "LAURA",
"middle_name": "ANN",
"credential": "OTR/L",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2012-09-13",
"last_updated": "2012-09-13",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "IL",
"license": "056006672",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Belleville, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 13, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.