Healthcare Provider Details

I. General information

NPI: 1295210433
Provider Name (Legal Business Name): MRS. BRITTANY THOMA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: BRITTANY KLINE

II. Dates (important events)

Enumeration Date: 10/02/2018
Last Update Date: 09/01/2022
Certification Date: 09/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6060 N COLLEGE AVE
INDIANAPOLIS IN
46220-1907
US

IV. Provider business mailing address

9602 TURNBERRY CT
CARMEL IN
46032-9372
US

V. Phone/Fax

Practice location:
  • Phone: 216-233-5574
  • Fax:
Mailing address:
  • Phone: 216-233-5574
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code222Q00000X
TaxonomyDevelopmental Therapist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-21-53609
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: