Provider Demographics
NPI:1447539986
Name:HOLST, MICHAEL CARL (OTR)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:CARL
Last Name:HOLST
Suffix:
Gender:M
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2620 SCRIPTURE ST
Mailing Address - Street 2:
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76201-4315
Mailing Address - Country:US
Mailing Address - Phone:940-297-6532
Mailing Address - Fax:940-297-6535
Practice Address - Street 1:2620 SCRIPTURE ST
Practice Address - Street 2:
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76201-4315
Practice Address - Country:US
Practice Address - Phone:940-297-6532
Practice Address - Fax:940-297-6535
Is Sole Proprietor?:No
Enumeration Date:2011-08-16
Last Update Date:2011-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX112785174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist