Provider Demographics
NPI:1184407678
Name:GRAVES, EMILEE NICOLE (PTA)
Entity type:Individual
Prefix:
First Name:EMILEE
Middle Name:NICOLE
Last Name:GRAVES
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 S MOUNT OLIVE ST STE A
Mailing Address - Street 2:
Mailing Address - City:SILOAM SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:72761-4203
Mailing Address - Country:US
Mailing Address - Phone:479-276-0828
Mailing Address - Fax:888-588-4381
Practice Address - Street 1:800 S MOUNT OLIVE ST STE A
Practice Address - Street 2:
Practice Address - City:SILOAM SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:72761-4203
Practice Address - Country:US
Practice Address - Phone:479-220-5361
Practice Address - Fax:888-588-4381
Is Sole Proprietor?:No
Enumeration Date:2023-08-17
Last Update Date:2024-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3518225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant