Individual
HOLLY SUZANNE SMITH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OTRL
Contact information
Practice address
629 W ELK AVE, ELIZABETHTON, TN 37643-2559
(423) 543-0073
Mailing address
719 W PINE ST, JOHNSON CITY, TN 37604-6513
(423) 967-5326
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
OT0000003042
TN
Other
Enumeration date
11/09/2006
Last updated
07/08/2007
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