Healthcare Provider Details

I. General information

NPI: 1750408969
Provider Name (Legal Business Name): THOMAS R GEHA L.AC., MAOM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/23/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21610 PACIFIC HWY
OCEAN PARK WA
98640
US

IV. Provider business mailing address

PO BOX 34
NAHCOTTA WA
98637-0034
US

V. Phone/Fax

Practice location:
  • Phone: 360-244-1037
  • Fax:
Mailing address:
  • Phone: 360-244-1037
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC00000274
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: