Provider Demographics
NPI:1598587107
Name:HOLM, KAIRA FAYE (LMT)
Entity type:Individual
Prefix:
First Name:KAIRA
Middle Name:FAYE
Last Name:HOLM
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 RED CLIFFS DR STE 36
Mailing Address - Street 2:
Mailing Address - City:ST GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84790-8129
Mailing Address - Country:US
Mailing Address - Phone:435-246-7767
Mailing Address - Fax:
Practice Address - Street 1:250 RED CLIFFS DR STE 36
Practice Address - Street 2:
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84790-8129
Practice Address - Country:US
Practice Address - Phone:435-246-7767
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-26
Last Update Date:2024-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT14153506-4701225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist