Provider Demographics
NPI:1174830913
Name:HOLMES, SHANA LANE (COTA/L)
Entity Type:Individual
Prefix:
First Name:SHANA
Middle Name:LANE
Last Name:HOLMES
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 857
Mailing Address - Street 2:
Mailing Address - City:SALTILLO
Mailing Address - State:MS
Mailing Address - Zip Code:38866-0857
Mailing Address - Country:US
Mailing Address - Phone:662-610-9473
Mailing Address - Fax:
Practice Address - Street 1:198 QUAIL CREEK RD
Practice Address - Street 2:
Practice Address - City:SALTILLO
Practice Address - State:MS
Practice Address - Zip Code:38866-9537
Practice Address - Country:US
Practice Address - Phone:662-610-9473
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-31
Last Update Date:2010-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS0386224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant