MEDICARE: ELLA HOLLAND MOT, OTR/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
1	225XP0200X	Pediatric Occupational Therapist	OT009851	GA

General Provider Information

NPI Number	:	1417886342
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELLA HOLLAND MOT, OTR/L

Provider Business Mailing Address
First Line	:	1000 JOHNSON FERRY RD STE B200
Second Line	:
City	:	MARIETTA
State	:	GA
Zip	:	30068-2196
Country	:	US
Telephone Number	:	770-526-1245
Fax Number	:

Provider Business Practice Location Address
First Line	:	1000 JOHNSON FERRY RD STE B200
Second Line	:
City	:	MARIETTA
State	:	GA
Zip	:	30068-2196
Country	:	US
Telephone Number	:	770-526-1245
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/16/2026
Last Update Date	:	05/16/2026

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