Provider Demographics
NPI:1740983121
Name:HOLLOWAY, SAMUEL ROSS
Entity type:Individual
Prefix:
First Name:SAMUEL
Middle Name:ROSS
Last Name:HOLLOWAY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44 VIGNE BLVD
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72223-4582
Mailing Address - Country:US
Mailing Address - Phone:501-350-4138
Mailing Address - Fax:
Practice Address - Street 1:956 MATHIAS DR
Practice Address - Street 2:
Practice Address - City:SPRINGDALE
Practice Address - State:AR
Practice Address - Zip Code:72762-0985
Practice Address - Country:US
Practice Address - Phone:479-419-9911
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-23
Last Update Date:2023-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist