Provider Demographics
NPI:1841650629
Name:HOLLISTER, NANCY MICHELE (COTA/L)
Entity type:Individual
Prefix:MRS
First Name:NANCY
Middle Name:MICHELE
Last Name:HOLLISTER
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1151 BIRDWELL DR
Mailing Address - Street 2:
Mailing Address - City:GALLATIN
Mailing Address - State:TN
Mailing Address - Zip Code:37066-3848
Mailing Address - Country:US
Mailing Address - Phone:615-300-1253
Mailing Address - Fax:615-758-5400
Practice Address - Street 1:2650 N MOUNT JULIET RD
Practice Address - Street 2:
Practice Address - City:MOUNT JULIET
Practice Address - State:TN
Practice Address - Zip Code:37122-8015
Practice Address - Country:US
Practice Address - Phone:615-758-4100
Practice Address - Fax:615-758-5450
Is Sole Proprietor?:No
Enumeration Date:2016-03-07
Last Update Date:2019-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVOTA-2279224Z00000X
COOTA.0001210224Z00000X
WAOC60968376224Z00000X
KY248331224Z00000X
TN1765224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1765Medicaid
TN1765Medicaid
TN1765Medicare PIN