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NPI Code Detail

MEDICARE: HOLLY RENEE CLIFTON C.O.T.A./L

MEDICARE:   HOLLY RENEE CLIFTON  C.O.T.A./L
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1224Z00000XOccupational Therapy Assistant705TN

General Provider Information

NPI Number : 1194822098
Entity Type Code : Individual
Provider Name (Legal Business Name) : HOLLY RENEE CLIFTON C.O.T.A./L
Provider Business Mailing Address
First Line : 2903 HIGHWAY 70 E
Second Line :
City : DICKSON
State : TN
Zip : 37055-6136
Country : US
Telephone Number : 415-446-4191
Fax Number :
Provider Business Practice Location Address
First Line : 812 N CHARLOTTE ST
Second Line :
City : DICKSON
State : TN
Zip : 37055-1009
Country : US
Telephone Number : 615-446-8045
Fax Number : 615-446-3138
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/20/2006
Last Update Date : 07/08/2007

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Directions to “ HOLLY RENEE CLIFTON C.O.T.A./L” Practice Location

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