Basic Information
| Provider Information | |||||||||
| NPI: | 1568943710 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LOVITT | ||||||||
| FirstName: | HOLLY | ||||||||
| MiddleName: | ANN | ||||||||
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| Credential: | COTA | ||||||||
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| OtherLastName: | WILLIAMS | ||||||||
| OtherFirstName: | HOLLY | ||||||||
| OtherMiddleName: | ANN | ||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 1409 COUNTY ROAD 807 | ||||||||
| Address2: | |||||||||
| City: | CLEBURNE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 760310307 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6822600041 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 206 WALLS DR | ||||||||
| Address2: | |||||||||
| City: | CLEBURNE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 760334045 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8176450668 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/26/2018 | ||||||||
| LastUpdateDate: | 08/26/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 224Z00000X | 215241 | TX | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapy Assistant |
No ID Information.