Individual
TYLER JAMES HOLLOWAY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OTR/L
Contact information
Practice address
16171 N BRINSON ST, NAMPA, ID 83687-5509
(208) 442-2525
Mailing address
16171 N BRINSON ST, NAMPA, ID 83687-5509
(208) 442-2525
Taxonomy
Speciality
Code
Description
License number
State
225XP0200X
Pediatric Occupational Therapist
Primary
OT-2206
ID
Other
Enumeration date
09/09/2020
Last updated
09/09/2020
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