Provider Demographics
NPI:1629293949
Name:SHERIDAN, HOLLY JILL
Entity Type:Individual
Prefix:
First Name:HOLLY
Middle Name:JILL
Last Name:SHERIDAN
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 1:199 FRONTIER TRL
Mailing Address - Street 2:
Mailing Address - City:POCAHONTAS
Mailing Address - State:AR
Mailing Address - Zip Code:72455-1379
Mailing Address - Country:US
Mailing Address - Phone:870-892-9156
Mailing Address - Fax:870-892-9156
Practice Address - Street 1:199 FRONTIER TRL
Practice Address - Street 2:
Practice Address - City:POCAHONTAS
Practice Address - State:AR
Practice Address - Zip Code:72455-1379
Practice Address - Country:US
Practice Address - Phone:870-892-9156
Practice Address - Fax:870-892-9156
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AROTR1086225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist