Provider Demographics
NPI:1003350885
Name:SMITH, HOLLY
Entity Type:Individual
Prefix:
First Name:HOLLY
Middle Name:
Last Name:SMITH
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 1:581 CR 115
Mailing Address - Street 2:
Mailing Address - City:HICKORY RIDGE
Mailing Address - State:AR
Mailing Address - Zip Code:72347-9203
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:581 CR 115
Practice Address - Street 2:
Practice Address - City:HICKORY RIDGE
Practice Address - State:AR
Practice Address - Zip Code:72347-9203
Practice Address - Country:US
Practice Address - Phone:870-208-5856
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-13
Last Update Date:2016-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AROT2016-045224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant