Individual
MRS. SHANNON HOLT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OT
Contact information
Practice address
2418 BLUE RIDGE RD, SUITE 100, RALEIGH, NC 27607-6480
(919) 782-5954
(919) 859-9444
Mailing address
3528 WADE AVENUE, #139, RALEIGH, NC 27607-4048
(919) 782-5954
(919) 859-9444
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
3358
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
13729
BLUE CROSS BLUE SHIELD
NC
01
—
5947795
AETNA
NC
01
—
D9498
MEDCOST
NC
Enumeration date
01/24/2006
Last updated
07/08/2007
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