MEDICARE: SHIRLEY THOMAS OT

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	225X00000X	Occupational Therapist	OT001002	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1891103826
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHIRLEY THOMAS OT

Provider Business Mailing Address
First Line	:	9800 HUTCHESON FERRY RD
Second Line	:
City	:	CHATTAHOOCHEE HILLS
State	:	GA
Zip	:	30268-2317
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	9800 HUTCHESON FERRY RD
Second Line	:
City	:	CHATTAHOOCHEE HILLS
State	:	GA
Zip	:	30268-2317
Country	:	US
Telephone Number	:	770-463-5398
Fax Number	:

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

Provider Enumeration Date	:	07/22/2014
Last Update Date	:	07/22/2014

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Directions to “ SHIRLEY THOMAS OT” Practice Location

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