Provider Demographics
NPI:1609686005
Name:DAVIS HOLLIDAY, LETITIA NICOLE (MASSAGE THERAPIST)
Entity type:Individual
Prefix:
First Name:LETITIA
Middle Name:NICOLE
Last Name:DAVIS HOLLIDAY
Suffix:
Gender:F
Credentials:MASSAGE THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6004 SILTSTONE LOOP
Mailing Address - Street 2:
Mailing Address - City:KILLEEN
Mailing Address - State:TX
Mailing Address - Zip Code:76542-5885
Mailing Address - Country:US
Mailing Address - Phone:512-277-4917
Mailing Address - Fax:
Practice Address - Street 1:6004 SILTSTONE LOOP
Practice Address - Street 2:
Practice Address - City:KILLEEN
Practice Address - State:TX
Practice Address - Zip Code:76542-5885
Practice Address - Country:US
Practice Address - Phone:512-277-4917
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-09
Last Update Date:2025-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX138725225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist