Individual
MR. DERIC LECHARLES HOLLOWAY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
COTA/L
Contact information
Practice address
95 TONETTA LAKE WAY, BREWSTER, NY 10509-2915
(914) 325-7197
Mailing address
95 TONETTA LAKE WAY, BREWSTER, NY 10509-2915
(914) 325-7197
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
008563
NY
Other
Enumeration date
04/01/2017
Last updated
04/01/2017
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