Healthcare Provider Details

I. General information

NPI: 1174750822
Provider Name (Legal Business Name): HOLLI JEAN WITHROW MOTRL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2009
Last Update Date: 06/19/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22593 THREE NOTCH RD RT. 235
CALIFORNIA MD
20619-3054
US

IV. Provider business mailing address

45675 CONNOR WAY
LEXINGTON PARK MD
20653-3374
US

V. Phone/Fax

Practice location:
  • Phone: 301-862-2505
  • Fax: 301-862-2548
Mailing address:
  • Phone: 240-298-6743
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number05776
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: