Healthcare Provider Details

I. General information

NPI: 1598268385
Provider Name (Legal Business Name): JAMES EDWARD HOLTSLAG MOTR/L
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/17/2018
Last Update Date: 08/02/2026
Certification Date: 08/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

960 S CHARLES G SEIVERS BLVD
CLINTON TN
37716-3882
US

IV. Provider business mailing address

8237 ZENITH LN
POWELL TN
37849-5017
US

V. Phone/Fax

Practice location:
  • Phone: 865-270-3178
  • Fax: 865-463-7687
Mailing address:
  • Phone: 248-765-1376
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number7405
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: