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NPI Code Detail

MEDICARE: HOLLY NICOLE COOTS

MEDICARE: HOLLY NICOLE COOTS
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
1106S00000XBehavior Technician

General Provider Information

NPI Number : 1730642851
Entity Type Code : Individual
Provider Name (Legal Business Name) : HOLLY NICOLE COOTS
Provider Business Mailing Address
First Line : 40 STATE HIGHWAY 83
Second Line :
City : DEFUNIAK SPRINGS
State : FL
Zip : 32433-7404
Country : US
Telephone Number : 850-585-9189
Fax Number : 850-951-0898
Provider Business Practice Location Address
First Line : 40 STATE HIGHWAY 83
Second Line :
City : DEFUNIAK SPRINGS
State : FL
Zip : 32433-7404
Country : US
Telephone Number : 850-585-9189
Fax Number : 850-951-0898
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/08/2019
Last Update Date : 04/08/2019

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Directions to “ HOLLY NICOLE COOTS ” Practice Location

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These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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