Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225000000X | Orthotic Fitter | C26328 | MD |
NPI | 1164622619 |
---|---|
Provider Name | Holli D Childress |
First Address | Richmond, VA 23230-3361 |
Second Address | Richmond, VA 23230-3361 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/07/2007 |
Last Update Date | 23/09/2008 |