Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0019X | Occupational Therapist - Physical Rehabilitation | OT-03988 | OH |
NPI | 1083257034 |
---|---|
Provider Name | Mr. John Alan Hollenbacher |
First Address | Lima, OH 45801-1318 |
Second Address | Lima, OH 45801-1318 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/10/2019 |
Last Update Date | 22/10/2019 |