Healthcare Provider Details

I. General information

NPI: 1588846075
Provider Name (Legal Business Name): GINGER LEIGH HOLLEY M.A., OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/27/2007
Last Update Date: 11/27/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1713 TELLICO DR
THOMPSONS STATION TN
37179-2307
US

IV. Provider business mailing address

1713 TELLICO DR
THOMPSONS STATION TN
37179-2307
US

V. Phone/Fax

Practice location:
  • Phone: 931-698-3420
  • Fax:
Mailing address:
  • Phone: 931-698-3420
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number0000003755
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: