Organization
THOMAS R. HOLMES, DBA DEMENTIA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
THOMAS R. HOLMES (OWNER)
(903) 561-9676
Entity
Organization
Contact information
Practice address
2358 MIRABEAU DR, TYLER, TX 75703-5867
(903) 561-9676
Mailing address
2358 MIRABEAU DR, TYLER, TX 75703-5867
(903) 561-9676
Taxonomy
Speciality
Code
Description
License number
State
225XG0600X
Gerontology Occupational Therapist
Primary
109348
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1134346380
INDIVIDUAL PROVIDER NPI
TX
Enumeration date
02/25/2009
Last updated
06/25/2012
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