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General NPI Number Information
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NPI Number | 1871288803
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Entity Type | Individual
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Provider Name | HOLLY LIESEGANG OTR/L
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Gender | Female
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Dates
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Enumeration Date | 04/06/2023
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Last Update Date | 04/06/2023
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Provider Practice Location Address
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Address Line | 4335 PHEASANT RIDGE RD
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City | ROANOKE
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State | VA
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Zip | 24014-5272
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Country | US
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Telephone | 540-725-8210
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Fax |
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Provider Business Mailing Address
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Address Line | 404 OLD CAMP CATAWBA RD
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City | BLOWING ROCK
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State | NC
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Zip | 28605-9220
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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 |
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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 | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 0119009869.
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License Number State | VA
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