Provider Demographics
NPI:1770637050
Name:RAINEY, HOLLY MCGREGOR (COTA-L)
Entity Type:Individual
Prefix:MRS
First Name:HOLLY
Middle Name:MCGREGOR
Last Name:RAINEY
Suffix:
Gender:F
Credentials:COTA-L
Other - Prefix:MISS
Other - First Name:HOLLY
Other - Middle Name:ANNE
Other - Last Name:MCGREGOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:COTA-L
Mailing Address - Street 1:8051 HIGHWAY 493
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:MS
Mailing Address - Zip Code:39305-9284
Mailing Address - Country:US
Mailing Address - Phone:601-297-8850
Mailing Address - Fax:
Practice Address - Street 1:711 AVIGNON DR
Practice Address - Street 2:
Practice Address - City:RIDGELAND
Practice Address - State:MS
Practice Address - Zip Code:39157-5120
Practice Address - Country:US
Practice Address - Phone:601-605-6777
Practice Address - Fax:601-605-8869
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSTA1803224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant