Individual
HOLLIE CLOUSE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA/L
Contact information
Practice address
1700 PAMALEE DR, FAYETTEVILLE, NC 28301-2824
(910) 488-2295
Mailing address
408 WILDERNESS RD, MIDDLESBORO, KY 40965
(606) 242-9336
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
11360
NC
224Z00000X
Occupational Therapy Assistant
3559
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3559
TN BOARD OF OT
TN
Enumeration date
11/13/2017
Last updated
04/29/2021
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