Individual
SHANA LANE HOLMES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA/L
Contact information
Practice address
198 QUAIL CREEK RD, SALTILLO, MS 38866-9537
(662) 610-9473
Mailing address
PO BOX 857, SALTILLO, MS 38866-0857
(662) 610-9473
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
0386
MS
Other
Enumeration date
08/31/2010
Last updated
08/31/2010
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