Provider Demographics
NPI:1811713894
Name:SWALLOW, HOLLY MARSHA
Entity type:Individual
Prefix:
First Name:HOLLY
Middle Name:MARSHA
Last Name:SWALLOW
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 1:1617 S 10TH ST
Mailing Address - Street 2:
Mailing Address - City:PONCA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:74601-7144
Mailing Address - Country:US
Mailing Address - Phone:580-176-2483
Mailing Address - Fax:
Practice Address - Street 1:1617 S 10TH ST
Practice Address - Street 2:
Practice Address - City:PONCA CITY
Practice Address - State:OK
Practice Address - Zip Code:74601-7144
Practice Address - Country:US
Practice Address - Phone:580-176-2483
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-25
Last Update Date:2024-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist