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General NPI Number Information
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NPI Number | 1558037382
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Entity Type | Individual
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Provider Name | MICHEL'LE HOLTON CMT
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Gender | Female
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Dates
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Enumeration Date | 08/20/2021
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Last Update Date | 08/20/2021
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Provider Practice Location Address
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Address Line | 494 S EMERSON AVE STE K
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City | GREENWOOD
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State | IN
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Zip | 46143-1953
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Country | US
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Telephone | 312-340-4957
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Fax |
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Provider Business Mailing Address
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Address Line | 986 BENTGRASS DR
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City | GREENWOOD
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State | IN
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Zip | 46143-6629
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Country | US
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Telephone |
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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 | MT21304733
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License Number State | IN
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