Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | OT2016-045 | AR |
NPI | 1003350885 |
---|---|
Provider Name | Holly Smith |
First Address | Hickory Ridge, AR 72347-9203 |
Second Address | Hickory Ridge, AR 72347-9203 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/12/2016 |
Last Update Date | 13/12/2016 |