Healthcare Provider Details

I. General information

NPI: 1326804600
Provider Name (Legal Business Name): HOLLY NICOLE RYAN OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/26/2024
Last Update Date: 02/26/2024
Certification Date: 02/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7501 OSLER DR STE 301
TOWSON MD
21204-7744
US

IV. Provider business mailing address

8908 QUAIL RUN DR
PERRY HALL MD
21128-9002
US

V. Phone/Fax

Practice location:
  • Phone: 410-337-1333
  • Fax:
Mailing address:
  • Phone: 443-841-0446
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XN1300X
TaxonomyNeurorehabilitation Occupational Therapist
License Number06567
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code225XP0019X
TaxonomyPhysical Rehabilitation Occupational Therapist
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: