Healthcare Provider Details

I. General information

NPI: 1578287330
Provider Name (Legal Business Name): KARLI HOLLAND OTD, OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/26/2022
Last Update Date: 09/26/2022
Certification Date: 09/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 PIPEMAKERS CIR STE 115
POOLER GA
31322-4168
US

IV. Provider business mailing address

11 SIBERT LN
FORT LEONARD WOOD MO
65473-1310
US

V. Phone/Fax

Practice location:
  • Phone: 912-988-1526
  • Fax:
Mailing address:
  • Phone: 804-592-7911
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License NumberOT008612
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: