Provider Demographics
NPI:1376857672
Name:HOLLIFIELD, GRACE VICTORIA (OTR/L)
Entity Type:Individual
Prefix:
First Name:GRACE
Middle Name:VICTORIA
Last Name:HOLLIFIELD
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:GRACE
Other - Middle Name:VICTORIA
Other - Last Name:WILLARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:COTA/L
Mailing Address - Street 1:1008 LAVENDER LN
Mailing Address - Street 2:
Mailing Address - City:KERNERSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27284-0038
Mailing Address - Country:US
Mailing Address - Phone:336-207-2397
Mailing Address - Fax:
Practice Address - Street 1:1294 PRIDDY RD
Practice Address - Street 2:
Practice Address - City:KING
Practice Address - State:NC
Practice Address - Zip Code:27021-7485
Practice Address - Country:US
Practice Address - Phone:336-296-1427
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-29
Last Update Date:2022-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7598224Z00000X
NC10602225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant