Healthcare Provider Details

I. General information

NPI: 1427725100
Provider Name (Legal Business Name): HOLLIS LYNN THARP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2021
Last Update Date: 08/30/2021
Certification Date: 08/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7727 AUGUSTA PINES DRIVE
SPRING TX
77389
US

IV. Provider business mailing address

918 WINDY RD
APEX NC
27502-2410
US

V. Phone/Fax

Practice location:
  • Phone: 216-772-1030
  • Fax:
Mailing address:
  • Phone: 216-772-1030
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: