Provider Demographics
NPI:1396019402
Name:HOLLOWAY, JADE ELISE (OTD, OTR/L)
Entity Type:Individual
Prefix:
First Name:JADE
Middle Name:ELISE
Last Name:HOLLOWAY
Suffix:
Gender:F
Credentials:OTD, OTR/L
Other - Prefix:DR
Other - First Name:JADE
Other - Middle Name:ELISE
Other - Last Name:HOLLOWAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2734 ESQUIRE WAY
Mailing Address - Street 2:
Mailing Address - City:TUCKER
Mailing Address - State:GA
Mailing Address - Zip Code:30084-2815
Mailing Address - Country:US
Mailing Address - Phone:678-833-6833
Mailing Address - Fax:
Practice Address - Street 1:140 DECATUR ST SE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30303-3204
Practice Address - Country:US
Practice Address - Phone:678-833-6833
Practice Address - Fax:770-517-5513
Is Sole Proprietor?:No
Enumeration Date:2012-03-07
Last Update Date:2023-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOT005424225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist