Provider Demographics
NPI:1790444123
Name:WITHERSPOON, HOLLIS STEHLIN (MA, RDT, LCAT)
Entity Type:Individual
Prefix:MS
First Name:HOLLIS
Middle Name:STEHLIN
Last Name:WITHERSPOON
Suffix:
Gender:F
Credentials:MA, RDT, LCAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:91R MESEROLE ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11206-2053
Mailing Address - Country:US
Mailing Address - Phone:646-710-0629
Mailing Address - Fax:
Practice Address - Street 1:91R MESEROLE ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11206-2053
Practice Address - Country:US
Practice Address - Phone:646-710-0629
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-13
Last Update Date:2021-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002641