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General NPI Number Information
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NPI Number | 1831568963
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Entity Type | Individual
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Provider Name | HOLLY MCGOVERN
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Gender | Female
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Dates
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Enumeration Date | 09/18/2015
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Last Update Date | 03/10/2020
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Provider Practice Location Address
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Address Line | 211 PLEASANT RIDGE RD
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City | EL PASO
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State | AR
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Zip | 72045-9741
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Country | US
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Telephone | 501-796-3995
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Fax | 501-796-0515
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Provider Business Mailing Address
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Address Line | 211 PLEASANT RIDGE RD
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City | EL PASO
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State | AR
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Zip | 72045-9741
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Country | US
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Telephone | 412-417-8743
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Fax |
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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 | 224Z00000X
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Taxonomy Name | Occupational Therapy Assistant
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License Number | OT-A697
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License Number State | AR
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Taxonomy #2
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | OTR2982
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License Number State | AR
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