Provider Demographics
NPI:1780812677
Name:SMALLWOOD, HOLLY GENEVA
Entity type:Individual
Prefix:MRS
First Name:HOLLY
Middle Name:GENEVA
Last Name:SMALLWOOD
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 1:175 SIDNEY DRIVE
Mailing Address - Street 2:
Mailing Address - City:MT. STERLING
Mailing Address - State:KY
Mailing Address - Zip Code:40353
Mailing Address - Country:US
Mailing Address - Phone:859-582-8321
Mailing Address - Fax:
Practice Address - Street 1:175 SIDNEY DR
Practice Address - Street 2:
Practice Address - City:MT STERLING
Practice Address - State:KY
Practice Address - Zip Code:40353-1087
Practice Address - Country:US
Practice Address - Phone:859-582-8321
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-30
Last Update Date:2009-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist