MEDICARE: KELLY ELIZABETH THOMAS M.A.

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	235Z00000X	Speech-Language Pathologist	RPE6073	CA

General Provider Information

NPI Number	:	1194952440
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELLY ELIZABETH THOMAS M.A.

Provider Business Mailing Address
First Line	:	1106 E SANTA CLARA ST
Second Line	:
City	:	VENTURA
State	:	CA
Zip	:	93001-3177
Country	:	US
Telephone Number	:	520-289-6357
Fax Number	:

Provider Business Practice Location Address
First Line	:	1106 E SANTA CLARA ST
Second Line	:
City	:	VENTURA
State	:	CA
Zip	:	93001-3177
Country	:	US
Telephone Number	:	520-289-6357
Fax Number	:

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

Provider Enumeration Date	:	06/14/2009
Last Update Date	:	10/06/2009

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