Provider Demographics
NPI:1982732475
Name:HOLMES, CASEY B (ATC)
Entity Type:Individual
Prefix:MR
First Name:CASEY
Middle Name:B
Last Name:HOLMES
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:536 BROOKS RD
Mailing Address - Street 2:
Mailing Address - City:THORNDIKE
Mailing Address - State:ME
Mailing Address - Zip Code:04986-3423
Mailing Address - Country:US
Mailing Address - Phone:207-568-4030
Mailing Address - Fax:
Practice Address - Street 1:536 BROOKS RD
Practice Address - Street 2:
Practice Address - City:THORNDIKE
Practice Address - State:ME
Practice Address - Zip Code:04986-3423
Practice Address - Country:US
Practice Address - Phone:207-568-4030
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEAT2912255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer