Provider Demographics
NPI:1295153161
Name:GARRISON, HOLLY
Entity type:Individual
Prefix:
First Name:HOLLY
Middle Name:
Last Name:GARRISON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:HOLLY
Other - Middle Name:
Other - Last Name:DALLAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OT
Mailing Address - Street 1:2076 DANIEL STUART SQ
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22191-3315
Mailing Address - Country:US
Mailing Address - Phone:703-492-5050
Mailing Address - Fax:703-492-5062
Practice Address - Street 1:2076 DANIEL STUART SQ
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22191-3315
Practice Address - Country:US
Practice Address - Phone:703-492-5050
Practice Address - Fax:703-492-5062
Is Sole Proprietor?:No
Enumeration Date:2014-03-28
Last Update Date:2014-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0119006244225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist