Provider Demographics
NPI:1669014692
Name:HOLT, MEAGAN NICOLE (MS,OTR/L)
Entity Type:Individual
Prefix:
First Name:MEAGAN
Middle Name:NICOLE
Last Name:HOLT
Suffix:
Gender:F
Credentials:MS,OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 11TH AVE NW
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:TN
Mailing Address - Zip Code:37398-1017
Mailing Address - Country:US
Mailing Address - Phone:931-308-3223
Mailing Address - Fax:
Practice Address - Street 1:2110 N JACKSON ST
Practice Address - Street 2:
Practice Address - City:TULLAHOMA
Practice Address - State:TN
Practice Address - Zip Code:37388-2208
Practice Address - Country:US
Practice Address - Phone:931-455-5189
Practice Address - Fax:931-393-2455
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-10
Last Update Date:2019-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN6393225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN446547Medicaid