Provider Demographics
NPI:1477000594
Name:HOLM, NICOLE (LMT, MMP)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:HOLM
Suffix:
Gender:F
Credentials:LMT, MMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3375 DOVER LN
Mailing Address - Street 2:
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59105
Mailing Address - Country:US
Mailing Address - Phone:406-670-0536
Mailing Address - Fax:
Practice Address - Street 1:2212 BROADWATER AVE STE D
Practice Address - Street 2:
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59102-4779
Practice Address - Country:US
Practice Address - Phone:406-670-0536
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-07
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT4222225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT81-3730830OtherMASSAGE THERAPIST