Healthcare Provider Details

I. General information

NPI: 1114080645
Provider Name (Legal Business Name): WES HOLLAND C.PED.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/18/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1758 PARK PL SUITE 300
MONTGOMERY AL
36106-1127
US

IV. Provider business mailing address

1055 STABLEWAY RD
PIKE ROAD AL
36064-2764
US

V. Phone/Fax

Practice location:
  • Phone: 334-538-7696
  • Fax:
Mailing address:
  • Phone: 334-277-1551
  • Fax: 909-740-2012

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code222Z00000X
TaxonomyOrthotist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: