MEDICARE: CAROLINE MATTIE HOLDER

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	106S00000X	Behavior Technician	RBT-26-547272	HI

General Provider Information

NPI Number	:	1821924291
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAROLINE MATTIE HOLDER

Provider Business Mailing Address
First Line	:	92-1129 PANANA ST APT 803
Second Line	:
City	:	KAPOLEI
State	:	HI
Zip	:	96707-3735
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	91-679 FORT WEAVER RD
Second Line	:
City	:	EWA BEACH
State	:	HI
Zip	:	96706
Country	:	US
Telephone Number	:	808-647-6242
Fax Number	:

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

Provider Enumeration Date	:	06/22/2026
Last Update Date	:	06/22/2026

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