Provider Demographics
NPI:1972843324
Name:HOLSHOUSER, NATALIE JILL (PTA)
Entity Type:Individual
Prefix:MRS
First Name:NATALIE
Middle Name:JILL
Last Name:HOLSHOUSER
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:523 CROWDER RD
Mailing Address - Street 2:523 CROWDER RD
Mailing Address - City:MAYFIELD
Mailing Address - State:KY
Mailing Address - Zip Code:42066-4207
Mailing Address - Country:US
Mailing Address - Phone:270-247-4873
Mailing Address - Fax:
Practice Address - Street 1:523 CROWDER RD
Practice Address - Street 2:523 CROWDER RD
Practice Address - City:MAYFIELD
Practice Address - State:KY
Practice Address - Zip Code:42066-4207
Practice Address - Country:US
Practice Address - Phone:270-247-4873
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-21
Last Update Date:2013-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYA01516314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility