Provider Demographics
NPI:1134346380
Name:HOLMES, THOMAS R (OTR)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:R
Last Name:HOLMES
Suffix:
Gender:M
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2358 MIRABEAU DR
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75703-5867
Mailing Address - Country:US
Mailing Address - Phone:903-561-9676
Mailing Address - Fax:903-561-9676
Practice Address - Street 1:2358 MIRABEAU DR
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75703-5867
Practice Address - Country:US
Practice Address - Phone:903-561-9676
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-19
Last Update Date:2012-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX109348225XG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XG0600XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXOA3329Medicare Oscar/Certification
TX8F20511Medicare Oscar/Certification