Healthcare Provider Details

I. General information

NPI: 1497599849
Provider Name (Legal Business Name): HOLLY PARKER LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/20/2024
Last Update Date: 06/20/2024
Certification Date: 06/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

403 LANG HILL HWY
BROOKS ME
04921-3627
US

IV. Provider business mailing address

403 LANG HILL HWY
BROOKS ME
04921-3627
US

V. Phone/Fax

Practice location:
  • Phone: 207-323-3409
  • Fax:
Mailing address:
  • Phone: 207-323-3409
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMT7728
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: