MEDICARE: MRS. JENNIFER MICHELLE HOLLIDAY OTR L

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	3071	AZ

General Provider Information

NPI Number	:	1609847300
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JENNIFER MICHELLE HOLLIDAY OTR L

Provider Business Mailing Address
First Line	:	PO BOX 3457
Second Line	:
City	:	CAREFREE
State	:	AZ
Zip	:	85377-3457
Country	:	US
Telephone Number	:	480-595-2184
Fax Number	:	480-595-0212

Provider Business Practice Location Address
First Line	:	17220 N BOSWELL BLVD
Second Line	:	SUITE L200
City	:	SUN CITY
State	:	AZ
Zip	:	85373-2000
Country	:	US
Telephone Number	:	623-977-4911
Fax Number	:	623-977-4919

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

Provider Enumeration Date	:	01/30/2006
Last Update Date	:	07/08/2007

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