Healthcare Provider Details

I. General information

NPI: 1588076475
Provider Name (Legal Business Name): NATHEN HOLDMAN MD, OTR, CSCS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2014
Last Update Date: 06/13/2026
Certification Date: 06/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

527 GOTT RD
ENID OK
73705-5103
US

IV. Provider business mailing address

527 GOTT RD
ENID OK
73705-5103
US

V. Phone/Fax

Practice location:
  • Phone: 228-376-0425
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number35.151689
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: