Healthcare Provider Details

I. General information

NPI: 1851790646
Provider Name (Legal Business Name): HOLLY BLAIS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/18/2014
Last Update Date: 12/28/2020
Certification Date: 12/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27 LONG MEADOW FARM DR
EPPING NH
03042-2910
US

IV. Provider business mailing address

27 LONG MEADOW FARM DR
EPPING NH
03042-2910
US

V. Phone/Fax

Practice location:
  • Phone: 603-235-9429
  • Fax:
Mailing address:
  • Phone: 603-235-9429
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-12-11718
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: