Provider Demographics
NPI:1225486269
Name:HOLMES, TARA (MS RD CSP LDN CBDT)
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:
Last Name:HOLMES
Suffix:
Gender:F
Credentials:MS RD CSP LDN CBDT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:85 WETHERBEE RD
Mailing Address - Street 2:
Mailing Address - City:WALTHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02453-7624
Mailing Address - Country:US
Mailing Address - Phone:617-538-9619
Mailing Address - Fax:
Practice Address - Street 1:85 WETHERBEE RD
Practice Address - Street 2:
Practice Address - City:WALTHAM
Practice Address - State:MA
Practice Address - Zip Code:02453-7624
Practice Address - Country:US
Practice Address - Phone:617-538-9619
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-01
Last Update Date:2016-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2666133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered