Provider Demographics
NPI:1861598286
Name:HOLLAND, JENNY D (OCCUPATIONAL THERAPI)
Entity type:Individual
Prefix:
First Name:JENNY
Middle Name:D
Last Name:HOLLAND
Suffix:
Gender:F
Credentials:OCCUPATIONAL THERAPI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4602 CUMBERLAND ROAD
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28306
Mailing Address - Country:US
Mailing Address - Phone:910-423-5622
Mailing Address - Fax:910-423-5538
Practice Address - Street 1:4602 CUMBERLAND ROAD
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28306
Practice Address - Country:US
Practice Address - Phone:910-423-5622
Practice Address - Fax:910-483-5538
Is Sole Proprietor?:No
Enumeration Date:2006-09-15
Last Update Date:2012-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4024225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist