Individual
TIERRA HOLLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2303 W OVERHILL RD, PEORIA, IL 61615-4215
(309) 657-1200
Mailing address
2303 W OVERHILL RD, PEORIA, IL 61615-4215
(309) 657-1200
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
057004341
IL
Other
Enumeration date
11/24/2021
Last updated
11/24/2021
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