MEDICARE: D'ANDRE MONIQUE HOLLAND OTD, 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	225X00000X	Occupational Therapist	13332	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	13332	OTHER	CA	CALIFORNIA BOARD OF OCCUPATIONAL THERAPY

General Provider Information

NPI Number	:	1659738839
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	D'ANDRE MONIQUE HOLLAND OTD, OTR/L

Provider Business Mailing Address
First Line	:	6830 S VAN NESS AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90047-1654
Country	:	US
Telephone Number	:	317-445-8573
Fax Number	:

Provider Business Practice Location Address
First Line	:	6830 S VAN NESS AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90047-1654
Country	:	US
Telephone Number	:	317-445-8573
Fax Number	:

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

Provider Enumeration Date	:	01/20/2016
Last Update Date	:	01/20/2016

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Directions to “ D'ANDRE MONIQUE HOLLAND OTD, OTR/L” Practice Location

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