Provider Demographics
NPI:1427882307
Name:HOLMES, LAURA B (LRT, CTRS, CBIS)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:B
Last Name:HOLMES
Suffix:
Gender:F
Credentials:LRT, CTRS, CBIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:404 HAWKS BLUFF CT
Mailing Address - Street 2:
Mailing Address - City:WAKE FOREST
Mailing Address - State:NC
Mailing Address - Zip Code:27587-3398
Mailing Address - Country:US
Mailing Address - Phone:919-412-2810
Mailing Address - Fax:
Practice Address - Street 1:404 HAWKS BLUFF CT
Practice Address - Street 2:
Practice Address - City:WAKE FOREST
Practice Address - State:NC
Practice Address - Zip Code:27587-3398
Practice Address - Country:US
Practice Address - Phone:919-412-2810
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-31
Last Update Date:2024-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4500225800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRecreation Therapist