Provider Demographics
NPI:1245470764
Name:HATTOM, HOLLY LYNN
Entity type:Individual
Prefix:
First Name:HOLLY
Middle Name:LYNN
Last Name:HATTOM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:HOLLY
Other - Middle Name:
Other - Last Name:NEWQUIST
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2661 RIVA RD
Mailing Address - Street 2:BLDG 600, SUITE 601
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21401-7353
Mailing Address - Country:US
Mailing Address - Phone:410-266-6626
Mailing Address - Fax:410-266-3026
Practice Address - Street 1:2661 RIVA RD
Practice Address - Street 2:BLDG 600, SUITE 601
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-7353
Practice Address - Country:US
Practice Address - Phone:410-266-6626
Practice Address - Fax:410-266-3026
Is Sole Proprietor?:No
Enumeration Date:2009-02-24
Last Update Date:2009-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA3295225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant