Active NPI
Mariah Hollister, PTA
- Physical Therapy Assistant
- Elk City, OK
National Provider Identifier
1710562780
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapy Assistant
- License
- 3131
- Practice address
- 911 McClain Dr
Elk City, OK 73644-2715 - Phone
- (580) 682-3044
- NPI assigned
- Mar 11, 2021
- Last updated
- May 10, 2021
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapy Assistant | 225200000X | 3131 | OK | Primary |
Addresses
Primary practice location
911 McClain Dr
Elk City, OK 73644-2715
Mailing address
911 McClain Dr
Elk City, OK 73644-2715
Phone (580) 682-3044
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 3131 | Other | OK | PTA LICENSE |
| 200967320A | Medicaid | OK |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3131 | OK | MD | Medical Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1615420800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1620604800000",
"number": "1710562780",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "911 MCCLAIN DR",
"city": "ELK CITY",
"state": "OK",
"postal_code": "736442715",
"telephone_number": "580-682-3044"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "911 MCCLAIN DR",
"city": "ELK CITY",
"state": "OK",
"postal_code": "736442715",
"telephone_number": "580-682-3044"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HOLLISTER",
"first_name": "MARIAH",
"credential": "PTA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2021-03-11",
"last_updated": "2021-05-10",
"certification_date": "2021-05-10",
"status": "A"
},
"taxonomies": [
{
"code": "225200000X",
"taxonomy_group": "",
"desc": "Physical Therapy Assistant",
"state": "OK",
"license": "3131",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PTA LICENSE",
"identifier": "3131",
"state": "OK"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "200967320A",
"state": "OK"
}
],
"endpoints": [],
"other_names": []
}Other providers in Elk City, OK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 10, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.