Healthcare Provider Details

I. General information

NPI: 1255092490
Provider Name (Legal Business Name): HOLLY MONIKA BARRETT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/09/2022
Last Update Date: 01/09/2022
Certification Date: 11/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7457 ALOMA AVE STE 201
WINTER PARK FL
32792-9172
US

IV. Provider business mailing address

5840 RED BUG LAKE RD STE 375
WINTER SPGS FL
32708-5011
US

V. Phone/Fax

Practice location:
  • Phone: 321-445-1287
  • Fax:
Mailing address:
  • Phone: 321-961-5058
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code224ZR0403X
TaxonomyDriving and Community Mobility Occupational Therapy Assistant
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: