Healthcare Provider Details

I. General information

NPI: 1134263692
Provider Name (Legal Business Name): HOLLIS ALTMAN M.A. CCC-A
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/17/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45 ROUND HILL RD
NORTHAMPTON MA
01060-2123
US

IV. Provider business mailing address

45 ROUND HILL RD
NORTHAMPTON MA
01060-2123
US

V. Phone/Fax

Practice location:
  • Phone: 413-582-1114
  • Fax: 413-587-9737
Mailing address:
  • Phone: 413-582-1114
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231HA2500X
TaxonomyAssistive Technology Supplier Audiologist
License Number7-W
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: