Healthcare Provider Details

I. General information

NPI: 1134165400
Provider Name (Legal Business Name): WILL THAMES O.T.R.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2006
Last Update Date: 02/11/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6715 TAYLOR CT
MONTGOMERY AL
36117-7708
US

IV. Provider business mailing address

PO BOX 242187
MONTGOMERY AL
36124-2187
US

V. Phone/Fax

Practice location:
  • Phone: 334-396-2110
  • Fax: 334-396-2115
Mailing address:
  • Phone: 334-396-3273
  • Fax: 334-396-4905

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number1138
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: