Healthcare Provider Details

I. General information

NPI: 1215588520
Provider Name (Legal Business Name): PURVIS THURMAN JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/27/2019
Last Update Date: 09/27/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2601 18TH ST NE
WASHINGTON DC
20018-1301
US

IV. Provider business mailing address

8414 POPLAR HILL DR
CLINTON MD
20735-3193
US

V. Phone/Fax

Practice location:
  • Phone: 202-541-7401
  • Fax:
Mailing address:
  • Phone: 301-379-8124
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License NumberOTA100000275
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: