Provider Demographics
NPI:1689121998
Name:HOLMAN, EMILY ROSE (DIPLOM, LAC)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:ROSE
Last Name:HOLMAN
Suffix:
Gender:F
Credentials:DIPLOM, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:296 BALLAMAHACK RD
Mailing Address - Street 2:
Mailing Address - City:WINDHAM
Mailing Address - State:CT
Mailing Address - Zip Code:06280-1130
Mailing Address - Country:US
Mailing Address - Phone:860-455-6620
Mailing Address - Fax:
Practice Address - Street 1:497 MIDDLE TPKE
Practice Address - Street 2:
Practice Address - City:STORRS
Practice Address - State:CT
Practice Address - Zip Code:06268-1655
Practice Address - Country:US
Practice Address - Phone:860-455-6620
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-02
Last Update Date:2016-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000668171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist