Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225CX0006X | Orientation and Mobility Training Provider | 22364 |
NPI | 1306326277 |
---|---|
Provider Name | Holly Short |
First Address | Morton, PA 19070-1918 |
Second Address | Secane, PA 19018-3423 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/08/2018 |
Last Update Date | 18/06/2021 |