Provider Demographics
NPI:1477017192
Name:HOLLINGSHED, OKERI J
Entity Type:Individual
Prefix:
First Name:OKERI
Middle Name:J
Last Name:HOLLINGSHED
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 1:1010 LAKEVIEW WAY
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30238-5659
Mailing Address - Country:US
Mailing Address - Phone:478-308-2898
Mailing Address - Fax:
Practice Address - Street 1:1010 LAKEVIEW WAY
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:GA
Practice Address - Zip Code:30238-5659
Practice Address - Country:US
Practice Address - Phone:478-308-2898
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-27
Last Update Date:2019-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOTA002280224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant