MEDICARE: NANCY L. HOLMES PT

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	101YM0800X	Mental Health Counselor	21338	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	21338	OTHER	CA	PSYCHIATRIC TECHNICIAN

General Provider Information

NPI Number	:	1417070418
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NANCY L. HOLMES PT

Provider Business Mailing Address
First Line	:	2489 LAKE TAHOE BLVD
Second Line	:	SUITE 27
City	:	SOUTH LAKE TAHOE
State	:	CA
Zip	:	96150-7728
Country	:	US
Telephone Number	:	530-543-6755
Fax Number	:	530-544-7128

Provider Business Practice Location Address
First Line	:	2489 LAKE TAHOE BLVD
Second Line	:	SUITE 27
City	:	SOUTH LAKE TAHOE
State	:	CA
Zip	:	96150-7728
Country	:	US
Telephone Number	:	530-543-6755
Fax Number	:	530-544-7128

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

Provider Enumeration Date	:	04/06/2007
Last Update Date	:	07/08/2007

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