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General NPI Number Information
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NPI Number | 1689819583
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Entity Type | Individual
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Provider Name | SAMANTHA HOLLEY CCC-SLP
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Gender | Female
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Dates
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Enumeration Date | 12/05/2008
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Last Update Date | 01/23/2025
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Provider Practice Location Address
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Address Line | CARIWON CHILDRENS PEDIATRIC THERAPY DEPARTMENT 4348 ELECTRIC RD 1ST FLOOR
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City | ROANOKE
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State | VA
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Zip | 24018
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Country | US
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Telephone | 540-769-0974
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Fax | 540-857-5384
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Provider Business Mailing Address
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Address Line | CARIWON CHILDRENS PEDIATRIC THERAPY DEPARTMENT 4348 ELECTRIC RD 1ST FLOOR
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City | ROANOKE
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State | VA
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Zip | 24018
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Country | US
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Telephone | 540-769-0974
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Fax | 540-857-5384
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 2202005305
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License Number State | VA
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