Healthcare Provider Details

I. General information

NPI: 1700033768
Provider Name (Legal Business Name): HOLLY ANN HENSHAW COTA/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2008
Last Update Date: 08/21/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 HARRIS RD
NASHUA NH
03062-2145
US

IV. Provider business mailing address

55 HARRIS RD
NASHUA NH
03062-2145
US

V. Phone/Fax

Practice location:
  • Phone: 603-888-1573
  • Fax:
Mailing address:
  • Phone: 603-888-1573
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number0301
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: