Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 0119008197 | VA |
NPI | 1003470105 |
---|---|
Provider Name | Alyson Marie Holt |
First Address | Quinton, VA 23141-2013 |
Second Address | Stafford, VA 22554-8331 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/04/2019 |
Last Update Date | 11/06/2019 |