MEDICARE: TERRELL DEJUAN THOMAS

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	106S00000X	Behavior Technician	106S0000X	OH

General Provider Information

NPI Number	:	1205765534
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TERRELL DEJUAN THOMAS

Provider Business Mailing Address
First Line	:	1212 SALEM AVE
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45406-5043
Country	:	US
Telephone Number	:	937-977-4624
Fax Number	:	937-977-4624

Provider Business Practice Location Address
First Line	:	1212 SALEM AVE
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45406-5043
Country	:	US
Telephone Number	:	937-977-4624
Fax Number	:	937-977-4624

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

Provider Enumeration Date	:	05/14/2026
Last Update Date	:	05/14/2026

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Directions to “ TERRELL DEJUAN THOMAS ” Practice Location

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