Provider Demographics
NPI:1215447792
Name:SOLLEY, VICTOR FRANK (OTR)
Entity type:Individual
Prefix:
First Name:VICTOR
Middle Name:FRANK
Last Name:SOLLEY
Suffix:
Gender:M
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4159 BERKELEY LNDG NW
Mailing Address - Street 2:
Mailing Address - City:KENNESAW
Mailing Address - State:GA
Mailing Address - Zip Code:30144-6152
Mailing Address - Country:US
Mailing Address - Phone:929-339-2180
Mailing Address - Fax:
Practice Address - Street 1:21008 76TH AVE W
Practice Address - Street 2:
Practice Address - City:EDMONDS
Practice Address - State:WA
Practice Address - Zip Code:98026-7104
Practice Address - Country:US
Practice Address - Phone:425-778-0107
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-10
Last Update Date:2017-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist