Healthcare Provider Details

I. General information

NPI: 1841255288
Provider Name (Legal Business Name): HOLLY LYNN HARDAWAY OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/19/2006
Last Update Date: 02/18/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7 PLEASANT PLAINS RD
FRANKLIN PARK NJ
08823-1307
US

IV. Provider business mailing address

7 PLEASANT PLAINS RD
FRANKLIN PARK NJ
08823-1307
US

V. Phone/Fax

Practice location:
  • Phone: 732-398-1790
  • Fax:
Mailing address:
  • Phone: 732-398-1790
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number46TR00050600
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: