Tyler James Holloway, OTR/L | |
16171 N Brinson St, Nampa, ID 83687-5509 | |
(208) 442-2525 | |
Not Available |
Full Name | Tyler James Holloway |
---|---|
Gender | Male |
Speciality | Occupational Therapist - Pediatrics |
Location | 16171 N Brinson St, Nampa, Idaho |
Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
Identifier | Type | State | Issuer |
---|---|---|---|
1053926816 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
225XP0200X | Occupational Therapist - Pediatrics | OT-2206 (Idaho) | Primary |
Provider Name | Current Physical Therapy Llc |
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Provider Type | Part B Supplier - Physical/occupational Therapy Group In Private Practice |
Provider Identifiers | NPI Number: 1518478734 PECOS PAC ID: 6507124823 Enrollment ID: O20171214001869 |
Mailing Address | Practice Location Address |
---|---|
Tyler James Holloway, OTR/L 16171 N Brinson St, Nampa, ID 83687-5509 Ph: (208) 442-2525 | Tyler James Holloway, OTR/L 16171 N Brinson St, Nampa, ID 83687-5509 Ph: (208) 442-2525 |
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