Provider Demographics
NPI:1366179046
Name:HOLMES, CHELSEA (OTA)
Entity type:Individual
Prefix:MISS
First Name:CHELSEA
Middle Name:
Last Name:HOLMES
Suffix:
Gender:F
Credentials:OTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:82721 S 4750 RD
Mailing Address - Street 2:
Mailing Address - City:STILWELL
Mailing Address - State:OK
Mailing Address - Zip Code:74960-6464
Mailing Address - Country:US
Mailing Address - Phone:918-575-6351
Mailing Address - Fax:
Practice Address - Street 1:1805 N YORK ST STE H
Practice Address - Street 2:
Practice Address - City:MUSKOGEE
Practice Address - State:OK
Practice Address - Zip Code:74403-1442
Practice Address - Country:US
Practice Address - Phone:918-912-2796
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-03
Last Update Date:2022-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AROT-A9772081P0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081P0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPediatric Rehabilitation Medicine