MEDICARE: NINOSKA MERCEDES 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	:	1669206801
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NINOSKA MERCEDES THOMAS

Provider Business Mailing Address
First Line	:	3218 OGDEN AVE
Second Line	:
City	:	OGDEN
State	:	UT
Zip	:	84401-3908
Country	:	US
Telephone Number	:	801-686-3556
Fax Number	:

Provider Business Practice Location Address
First Line	:	2510 WASHINGTON BLVD
Second Line	:
City	:	OGDEN
State	:	UT
Zip	:	84401-3137
Country	:	US
Telephone Number	:	801-686-3556
Fax Number	:

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

Provider Enumeration Date	:	08/29/2024
Last Update Date	:	08/29/2024

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Directions to “ NINOSKA MERCEDES THOMAS ” Practice Location

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