MEDICARE: MRS. MAUREEN HOLDEN CMT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist

General Provider Information

NPI Number	:	1093066862
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MAUREEN HOLDEN CMT

Provider Business Mailing Address
First Line	:	1524 RED TAIL DR
Second Line	:
City	:	ROCK SPRINGS
State	:	WY
Zip	:	82901-5882
Country	:	US
Telephone Number	:	307-362-2610
Fax Number	:

Provider Business Practice Location Address
First Line	:	2908 FOOTHILL BLVD STE B
Second Line	:
City	:	ROCK SPRINGS
State	:	WY
Zip	:	82901-4956
Country	:	US
Telephone Number	:	307-362-5338
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/19/2012
Last Update Date	:	09/19/2012

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