Provider Demographics
NPI:1639851819
Name:SIMS, HOLLY SUSAN (COTA/L)
Entity type:Individual
Prefix:
First Name:HOLLY
Middle Name:SUSAN
Last Name:SIMS
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:HOLLY
Other - Middle Name:SUSAN
Other - Last Name:VENABLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2459 FAIRWAY OAKS DR
Mailing Address - Street 2:
Mailing Address - City:BARTLETT
Mailing Address - State:TN
Mailing Address - Zip Code:38134-5588
Mailing Address - Country:US
Mailing Address - Phone:615-969-7696
Mailing Address - Fax:
Practice Address - Street 1:131 N TUCKER ST
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38104-2636
Practice Address - Country:US
Practice Address - Phone:615-969-7696
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-07
Last Update Date:2023-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2830224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant