Provider Demographics
NPI:1962490003
Name:HOLLMAN, WENDY RENEE' (AT,C)
Entity type:Individual
Prefix:MS
First Name:WENDY
Middle Name:RENEE'
Last Name:HOLLMAN
Suffix:
Gender:F
Credentials:AT,C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1729 DEER PATH DR
Mailing Address - Street 2:
Mailing Address - City:MT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29464-7711
Mailing Address - Country:US
Mailing Address - Phone:843-971-7199
Mailing Address - Fax:
Practice Address - Street 1:2000 BAINBRIDGE AVE
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29405-2607
Practice Address - Country:US
Practice Address - Phone:843-746-0807
Practice Address - Fax:843-746-0826
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCSCDHEC - 3052255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer