MEDICARE: MRS. JENNY HOLDEN OTR

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist	100707	TX

General Provider Information

NPI Number	:	1598164063
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JENNY HOLDEN OTR

Provider Business Mailing Address
First Line	:	1061 COUNTY ROAD 411
Second Line	:
City	:	LEXINGTON
State	:	TX
Zip	:	78947-4900
Country	:	US
Telephone Number	:	325-669-3743
Fax Number	:

Provider Business Practice Location Address
First Line	:	1061 COUNTY ROAD 411
Second Line	:
City	:	LEXINGTON
State	:	TX
Zip	:	78947-4900
Country	:	US
Telephone Number	:	325-669-3743
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/20/2014
Last Update Date	:	08/20/2014

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