Provider Demographics
NPI:1710052667
Name:VALENTINE-HOLLIMAN, MALODY MALENDA (OTR-L)
Entity Type:Individual
Prefix:MRS
First Name:MALODY
Middle Name:MALENDA
Last Name:VALENTINE-HOLLIMAN
Suffix:
Gender:F
Credentials:OTR-L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1931
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30903-1931
Mailing Address - Country:US
Mailing Address - Phone:706-829-6175
Mailing Address - Fax:
Practice Address - Street 1:4405 EVANS TO LOCKS RD
Practice Address - Street 2:
Practice Address - City:EVANS
Practice Address - State:GA
Practice Address - Zip Code:30809-3603
Practice Address - Country:US
Practice Address - Phone:706-854-1598
Practice Address - Fax:706-854-8136
Is Sole Proprietor?:No
Enumeration Date:2006-11-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA002383225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00938165AMedicaid