Healthcare Provider Details

I. General information

NPI: 1891875035
Provider Name (Legal Business Name): HOLLY J WHEELER OT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/16/2006
Last Update Date: 05/13/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

159 WEST MAIN STREET
NEWARK OH
43055-5007
US

IV. Provider business mailing address

11177 LAMBS LN
NEWARK OH
43055-9779
US

V. Phone/Fax

Practice location:
  • Phone: 740-345-2837
  • Fax: 740-345-4793
Mailing address:
  • Phone: 740-763-0408
  • Fax: 740-763-0475

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number2290
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: