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General NPI Number Information
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NPI Number | 1144041187
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Entity Type | Individual
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Provider Name | NAOMI HOLT
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Gender | Female
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Dates
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Enumeration Date | 10/22/2024
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Last Update Date | 10/22/2024
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Provider Practice Location Address
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Address Line | 120 E 4TH ST
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City | RUSSELLVILLE
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State | AR
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Zip | 72801-5132
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Country | US
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Telephone | 501-585-8304
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Fax |
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Provider Business Mailing Address
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Address Line | 2401 W MAIN ST APT 1C
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City | CLARKSVILLE
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State | AR
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Zip | 72830-8058
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Country | US
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Telephone | 501-585-8304
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | 3825
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License Number State | AR
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