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General NPI Number Information
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NPI Number | 1154480804
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Entity Type | Individual
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Provider Name | MARY E THOMSEN CERTIFIED FITTER FOR
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Gender | Female
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Dates
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Enumeration Date | 12/08/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 173 CHERRY OAK TRAIL
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City | PETAL
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State | MS
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Zip | 39465
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Country | US
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Telephone | 601-543-0268
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Fax |
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Provider Business Mailing Address
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Address Line | 173 CHERRY OAK TRAIL
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City | PETAL
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State | MS
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Zip | 39465
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Country | US
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Telephone | 601-543-0268
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225000000X
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Taxonomy Name | Orthotic Fitter
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License Number |
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License Number State |
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