Individual
MARIAH HOLLISTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
911 MCCLAIN DR, ELK CITY, OK 73644-2715
(580) 682-3044
Mailing address
911 MCCLAIN DR, ELK CITY, OK 73644-2715
(580) 682-3044
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
3131
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200967320A
—
OK
01
—
3131
PTA LICENSE
OK
Enumeration date
03/11/2021
Last updated
05/10/2021
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