Provider Demographics
NPI:1679532006
Name:HOLT, KEVIN R (PHD)
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:R
Last Name:HOLT
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:204 N HAMILTON ST
Mailing Address - Street 2:SUITE 3
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23221-2662
Mailing Address - Country:US
Mailing Address - Phone:804-353-9780
Mailing Address - Fax:804-358-0301
Practice Address - Street 1:2048 JOHN ROLFE PKWY
Practice Address - Street 2:SUITE A-9
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23238-8111
Practice Address - Country:US
Practice Address - Phone:804-353-9780
Practice Address - Fax:804-358-0301
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2201001228231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist