Healthcare Provider Details

I. General information

NPI: 1235228396
Provider Name (Legal Business Name): THOMAS HENRY PARTAIN L.O.T.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/12/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 RICKER RD
SALEM IL
62881-4263
US

IV. Provider business mailing address

3751 SKILLET FORK ROAD P.O. BOX 176
IUKA IL
62849
US

V. Phone/Fax

Practice location:
  • Phone: 618-548-3194
  • Fax: 618-548-4902
Mailing address:
  • Phone: 618-323-6363
  • Fax: 618-323-6363

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: