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General NPI Number Information
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NPI Number | 1134375900
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Entity Type | Individual
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Provider Name | E'DEE HOLLEY OTA
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Gender | Female
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Dates
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Enumeration Date | 08/13/2008
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Last Update Date | 08/13/2008
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Provider Practice Location Address
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Address Line | 1107 S CLAY ST
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City | ENNIS
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State | TX
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Zip | 75119-6414
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Country | US
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Telephone | 972-875-9277
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Fax | 972-875-9385
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Provider Business Mailing Address
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Address Line | 1401 LYNDALE DR
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City | ENNIS
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State | TX
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Zip | 75119-2323
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Country | US
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Telephone | 972-875-6777
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 224Z00000X
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Taxonomy Name | Occupational Therapy Assistant
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License Number | 403615
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License Number State | TX
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