Provider Demographics
NPI:1841255288
Name:HARDAWAY, HOLLY LYNN (OTR)
Entity type:Individual
Prefix:MS
First Name:HOLLY
Middle Name:LYNN
Last Name:HARDAWAY
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 PLEASANT PLAINS RD
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:08823-1307
Mailing Address - Country:US
Mailing Address - Phone:732-398-1790
Mailing Address - Fax:
Practice Address - Street 1:7 PLEASANT PLAINS RD
Practice Address - Street 2:
Practice Address - City:FRANKLIN PARK
Practice Address - State:NJ
Practice Address - Zip Code:08823-1307
Practice Address - Country:US
Practice Address - Phone:732-398-1790
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-19
Last Update Date:2014-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TR00050600225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist