Provider Demographics
NPI:1447606983
Name:HOLLAND, CORINNE TAYLOR (MOT, OTR/L)
Entity Type:Individual
Prefix:
First Name:CORINNE
Middle Name:TAYLOR
Last Name:HOLLAND
Suffix:
Gender:F
Credentials:MOT, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:333 E PALMYRA DR
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23462-5916
Mailing Address - Country:US
Mailing Address - Phone:757-374-9702
Mailing Address - Fax:
Practice Address - Street 1:1401 HALSTEAD AVE
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23502-2003
Practice Address - Country:US
Practice Address - Phone:757-857-0481
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-13
Last Update Date:2016-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0119006257225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist