MEDICARE: DONMONIQUE R BOWE 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

General Provider Information

NPI Number	:	1447762265
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DONMONIQUE R BOWE THOMAS

Provider Business Mailing Address
First Line	:	500 FAIRWAY DR STE 102
Second Line	:
City	:	DEERFIELD BEACH
State	:	FL
Zip	:	33441-1817
Country	:	US
Telephone Number	:	888-880-9270
Fax Number	:

Provider Business Practice Location Address
First Line	:	6992 NW 30TH TER
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33309-1341
Country	:	US
Telephone Number	:	954-643-0138
Fax Number	:

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

Provider Enumeration Date	:	11/02/2017
Last Update Date	:	11/02/2017

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Directions to “ DONMONIQUE R BOWE THOMAS ” Practice Location

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