Provider Demographics
NPI:1083125769
Name:BRINEMAN, HOLLIE RHODUS (MS, OTR/L)
Entity Type:Individual
Prefix:
First Name:HOLLIE
Middle Name:RHODUS
Last Name:BRINEMAN
Suffix:
Gender:F
Credentials:MS, OTR/L
Other - Prefix:
Other - First Name:HOLLIE
Other - Middle Name:M
Other - Last Name:RHODUS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4640 MARTIN ROAD
Mailing Address - Street 2:
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30041-5571
Mailing Address - Country:US
Mailing Address - Phone:678-679-1261
Mailing Address - Fax:678-250-9010
Practice Address - Street 1:4640 MARTIN RD
Practice Address - Street 2:
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30041-5542
Practice Address - Country:US
Practice Address - Phone:678-679-1261
Practice Address - Fax:678-250-9010
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-20
Last Update Date:2017-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOT006856225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist