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General NPI Number Information
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NPI Number | 1336499722
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Entity Type | Organization
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Legal Business Name | HOLLY A. NELSON, PEDIATRIC OCCUPATIONAL THERAPY, LLC
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Dates
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Enumeration Date | 09/13/2012
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Last Update Date | 09/13/2012
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Provider Practice Location Address
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Address Line | 3811 CRESTVALE TER
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City | BALTIMORE
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State | MD
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Zip | 21236-5201
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Country | US
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Telephone | 410-882-1345
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Fax |
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Provider Business Mailing Address
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Address Line | 3811 CRESTVALE TER
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City | BALTIMORE
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State | MD
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Zip | 21236-5201
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | HOLLY NELSON
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Credential | OTR/L
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Telephone | 410-882-1345
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 03646
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License Number State | MD
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