MEDICARE: SUSAN RITCHIE HOLT DI

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	252Y00000X	Early Intervention Provider Agency		KY

General Provider Information

NPI Number	:	1336949452
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSAN RITCHIE HOLT DI

Provider Business Mailing Address
First Line	:	762 ROLLING MEADOWS RD
Second Line	:
City	:	GRAND RIVERS
State	:	KY
Zip	:	42045-9194
Country	:	US
Telephone Number	:	270-816-0866
Fax Number	:

Provider Business Practice Location Address
First Line	:	762 ROLLING MEADOWS RD
Second Line	:
City	:	GRAND RIVERS
State	:	KY
Zip	:	42045-9194
Country	:	US
Telephone Number	:	270-816-0866
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/17/2025
Last Update Date	:	03/17/2025

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