MEDICARE: PATRICIA 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	:	1477074557
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PATRICIA THOMAS

Provider Business Mailing Address
First Line	:	4158 W US HIGHWAY 90 STE 101
Second Line	:
City	:	LAKE CITY
State	:	FL
Zip	:	32055-4883
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4158 W US HIGHWAY 90
Second Line	:	101
City	:	LAKE CITY
State	:	FL
Zip	:	32025-3202
Country	:	US
Telephone Number	:	352-284-6057
Fax Number	:

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

Provider Enumeration Date	:	06/29/2017
Last Update Date	:	06/29/2017

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Directions to “ PATRICIA THOMAS ” Practice Location

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