Healthcare Provider Details

I. General information

NPI: 1962758334
Provider Name (Legal Business Name): THOMAS JAMES LANGHAM M.ED.,COMS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2012
Last Update Date: 08/03/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

912 NORTH HAWLEY ROAD ROOM 220
MILWAUKEE WI
53213-3222
US

IV. Provider business mailing address

912 NORTH HAWLEY ROAD ROOM 220
MILWAUKEE WI
53213-3222
US

V. Phone/Fax

Practice location:
  • Phone: 414-302-2765
  • Fax: 414-302-6231
Mailing address:
  • Phone: 414-302-2765
  • Fax: 414-302-6231

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255R0406X
TaxonomyBlind Rehabilitation Specialist/Technologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: