Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225XG0600X | Occupational Therapist - Gerontology | OT00000718 | WA |
Y | 225XP0019X | Occupational Therapist - Physical Rehabilitation | OT00000718 | WA |
NPI | 1255612743 |
---|---|
Provider Name | Mr. Randall Steven Hollman |
First Address | Spokane, WA 99223-1282 |
Second Address | Spokane, WA 99223-1282 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/08/2011 |
Last Update Date | 29/08/2011 |