Provider Demographics
NPI:1124402318
Name:HOLT, LAURA J (LMT, CMCP)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:J
Last Name:HOLT
Suffix:
Gender:F
Credentials:LMT, CMCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:312 WATER ST
Mailing Address - Street 2:P.O.BOX 762
Mailing Address - City:SKOWHEGAN
Mailing Address - State:ME
Mailing Address - Zip Code:04976-1734
Mailing Address - Country:US
Mailing Address - Phone:207-649-0468
Mailing Address - Fax:
Practice Address - Street 1:312 WATER ST
Practice Address - Street 2:
Practice Address - City:SKOWHEGAN
Practice Address - State:ME
Practice Address - Zip Code:04976-1734
Practice Address - Country:US
Practice Address - Phone:207-649-0468
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-17
Last Update Date:2015-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMT4401225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist