Provider Demographics
NPI:1174979371
Name:FOSTER, HOLLY ANN (LMBT)
Entity type:Individual
Prefix:MRS
First Name:HOLLY
Middle Name:ANN
Last Name:FOSTER
Suffix:
Gender:F
Credentials:LMBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 MARTIN AVE
Mailing Address - Street 2:
Mailing Address - City:BOONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27011-8166
Mailing Address - Country:US
Mailing Address - Phone:336-671-3157
Mailing Address - Fax:
Practice Address - Street 1:106 MARTIN AVE
Practice Address - Street 2:
Practice Address - City:BOONVILLE
Practice Address - State:NC
Practice Address - Zip Code:27011-8166
Practice Address - Country:US
Practice Address - Phone:336-671-3157
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-06
Last Update Date:2016-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC01838225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist