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General NPI Number Information
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NPI Number | 1568243814
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Entity Type | Individual
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Provider Name | MELISSA NICOLE HOLMES LMT
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Gender | Female
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Dates
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Enumeration Date | 10/12/2023
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Last Update Date | 10/12/2023
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Provider Practice Location Address
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Address Line | 369 MONTAUK HWY
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City | EAST MORICHES
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State | NY
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Zip | 11940-1356
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Country | US
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Telephone | 631-909-3810
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Fax |
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Provider Business Mailing Address
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Address Line | 107 MASTIC BEACH RD
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City | MASTIC BEACH
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State | NY
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Zip | 11951-2200
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Country | US
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Telephone | 631-317-5214
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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 | 021841
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License Number State | NY
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