Healthcare Provider Details

I. General information

NPI: 1326857350
Provider Name (Legal Business Name): JORDAN THOMAS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/03/2025
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 SUTTON RD S
FORT MILL SC
29715-8439
US

IV. Provider business mailing address

9621 COMMONS EAST DR APT A
CHARLOTTE NC
28277-0445
US

V. Phone/Fax

Practice location:
  • Phone: 803-598-3661
  • Fax:
Mailing address:
  • Phone: 814-691-7113
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number7491
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number17475
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: