MEDICARE: PHINCY PHILIP THOMAS MS, OTR/L

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist	116340	TX
2	171W00000X	Contractor	012120	NY

General Provider Information

NPI Number	:	1154699494
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PHINCY PHILIP THOMAS MS, OTR/L

Provider Business Mailing Address
First Line	:	5907 NINE MILE LN
Second Line	:
City	:	MISSOURI CITY
State	:	TX
Zip	:	77459-2590
Country	:	US
Telephone Number	:	914-564-6550
Fax Number	:	281-778-5166

Provider Business Practice Location Address
First Line	:	5907 NINE MILE LN
Second Line	:
City	:	MISSOURI CITY
State	:	TX
Zip	:	77459-2590
Country	:	US
Telephone Number	:	914-564-6550
Fax Number	:	281-778-5166

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/01/2011
Last Update Date	:	11/29/2016

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