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: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5750 BERRYHILL RD
MILTON FL
32570-8276
US

IV. Provider business mailing address

11945 SAN JOSE BLVD STE 300
JACKSONVILLE FL
32223-1627
US

V. Phone/Fax

Practice location:
  • Phone: 850-623-0543
  • Fax: 850-623-5479
Mailing address:
  • Phone: 904-396-1725
  • Fax: 904-396-4893

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT23577
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: