Provider Demographics
NPI:1366954539
Name:HOLLOWAY, JAMIE ANN
Entity type:Individual
Prefix:
First Name:JAMIE
Middle Name:ANN
Last Name:HOLLOWAY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2623 SE 30TH CT
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:OR
Mailing Address - Zip Code:97123-7927
Mailing Address - Country:US
Mailing Address - Phone:503-730-7151
Mailing Address - Fax:
Practice Address - Street 1:2350 NE GRIFFIN OAKS ST STE 100
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:OR
Practice Address - Zip Code:97124-2374
Practice Address - Country:US
Practice Address - Phone:503-208-6278
Practice Address - Fax:503-208-6276
Is Sole Proprietor?:No
Enumeration Date:2017-10-27
Last Update Date:2017-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR19699225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist