Provider Demographics
NPI:1083881361
Name:HOLT, MELANIE SLEDGE (LPTA)
Entity Type:Individual
Prefix:
First Name:MELANIE
Middle Name:SLEDGE
Last Name:HOLT
Suffix:
Gender:F
Credentials:LPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:128 EDGEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:LOUISBURG
Mailing Address - State:NC
Mailing Address - Zip Code:27549-2111
Mailing Address - Country:US
Mailing Address - Phone:919-495-0996
Mailing Address - Fax:
Practice Address - Street 1:509 W GANNON AVE
Practice Address - Street 2:
Practice Address - City:ZEBULON
Practice Address - State:NC
Practice Address - Zip Code:27597-2509
Practice Address - Country:US
Practice Address - Phone:919-269-9621
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-15
Last Update Date:2008-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1929174400000X
174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist