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General NPI Number Information
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NPI Number | 1376145540
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Entity Type | Organization
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Legal Business Name | HOLISTIC AIM THERAPY, LLC
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Dates
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Enumeration Date | 11/12/2020
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Last Update Date | 11/12/2020
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Provider Practice Location Address
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Address Line | 11600 LEGEND GLEN DR
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City | BOWIE
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State | MD
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Zip | 20720-3458
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Country | US
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Telephone | 954-226-8079
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Fax |
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Provider Business Mailing Address
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Address Line | 11600 LEGEND GLEN DR
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City | BOWIE
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State | MD
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Zip | 20720-3458
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Country | US
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Telephone | 954-226-8079
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Fax |
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Authorized Official
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Title or Position | OCCUPATIONAL THERAPIST
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Name | AFRICA MINCEY
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Credential | OTR/L
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Telephone | 954-226-8079
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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