Provider Demographics
NPI:1801325824
Name:MEESE, HOLLY (LAT, ATC)
Entity type:Individual
Prefix:
First Name:HOLLY
Middle Name:
Last Name:MEESE
Suffix:
Gender:F
Credentials:LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 BROTHERS LN APT 307
Mailing Address - Street 2:
Mailing Address - City:DALTON
Mailing Address - State:GA
Mailing Address - Zip Code:30720-7336
Mailing Address - Country:US
Mailing Address - Phone:770-375-8211
Mailing Address - Fax:
Practice Address - Street 1:5178 ROUND POND RD
Practice Address - Street 2:
Practice Address - City:LA FAYETTE
Practice Address - State:GA
Practice Address - Zip Code:30728-4725
Practice Address - Country:US
Practice Address - Phone:706-638-2342
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-05
Last Update Date:2017-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAT0029502255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer