Provider Demographics
NPI:1598828105
Name:HOLLEY, MARTHA ANN (OTR L CHT)
Entity Type:Individual
Prefix:MS
First Name:MARTHA
Middle Name:ANN
Last Name:HOLLEY
Suffix:
Gender:F
Credentials:OTR L CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8075 MADISON BLVD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:MADISON
Mailing Address - State:AL
Mailing Address - Zip Code:35758-2042
Mailing Address - Country:US
Mailing Address - Phone:256-270-9595
Mailing Address - Fax:256-489-6545
Practice Address - Street 1:8075 MADISON BLVD
Practice Address - Street 2:SUITE 101
Practice Address - City:MADISON
Practice Address - State:AL
Practice Address - Zip Code:35758-2042
Practice Address - Country:US
Practice Address - Phone:256-270-9595
Practice Address - Fax:256-489-6545
Is Sole Proprietor?:No
Enumeration Date:2006-12-18
Last Update Date:2022-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA000960225X00000X
GA9711000526225XH1200X
AL4585225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA67BBBHHMedicare ID - Type Unspecified