Provider Demographics
NPI:1174750822
Name:WITHROW, HOLLI JEAN (MOTRL)
Entity type:Individual
Prefix:MRS
First Name:HOLLI
Middle Name:JEAN
Last Name:WITHROW
Suffix:
Gender:F
Credentials:MOTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45675 CONNOR WAY
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON PARK
Mailing Address - State:MD
Mailing Address - Zip Code:20653-3374
Mailing Address - Country:US
Mailing Address - Phone:240-298-6743
Mailing Address - Fax:
Practice Address - Street 1:22593 THREE NOTCH RD
Practice Address - Street 2:RT. 235
Practice Address - City:CALIFORNIA
Practice Address - State:MD
Practice Address - Zip Code:20619-3054
Practice Address - Country:US
Practice Address - Phone:301-862-2505
Practice Address - Fax:301-862-2548
Is Sole Proprietor?:No
Enumeration Date:2009-06-19
Last Update Date:2009-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD05776225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist