Provider Demographics
NPI:1164622619
Name:CHILDRESS, HOLLI D (COF, CFO)
Entity Type:Individual
Prefix:
First Name:HOLLI
Middle Name:D
Last Name:CHILDRESS
Suffix:
Gender:F
Credentials:COF, CFO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2034 DABNEY RD
Mailing Address - Street 2:SUITE C
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23230-3361
Mailing Address - Country:US
Mailing Address - Phone:804-649-9043
Mailing Address - Fax:804-783-8212
Practice Address - Street 1:2034 DABNEY RD
Practice Address - Street 2:SUITE C
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23230-3361
Practice Address - Country:US
Practice Address - Phone:804-649-9043
Practice Address - Fax:804-783-8212
Is Sole Proprietor?:No
Enumeration Date:2007-07-23
Last Update Date:2008-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC26328225000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225000000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotic Fitter