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General NPI Number Information
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NPI Number | 1336650084
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Entity Type | Individual
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Provider Name | SHIRLEY MARIE O'HEARN HOLM LMT
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Gender | Female
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Dates
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Enumeration Date | 10/21/2017
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Last Update Date | 03/17/2018
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Provider Practice Location Address
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Address Line | 113 W MAIN ST
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City | MISSOULA
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State | MT
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Zip | 59802-4336
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Country | US
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Telephone | 406-499-1049
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Fax |
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Provider Business Mailing Address
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Address Line | 34059 SHEEP CAMP RD
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City | BONNER
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State | MT
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Zip | 59823-9803
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Country | US
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Telephone | 406-499-1049
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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 | LMT-LMT-LIC-12457
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License Number State | MT
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