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General NPI Number Information
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NPI Number | 1285442566
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Entity Type | Individual
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Provider Name | KATIE NICOLE THOMERSON OT
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Gender | Female
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Dates
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Enumeration Date | 12/19/2024
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Last Update Date | 12/20/2024
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Provider Practice Location Address
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Address Line | 3354 GREYSTONE WAY
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City | VALDOSTA
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State | GA
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Zip | 31605-1096
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Country | US
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Telephone | 229-244-3552
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Fax |
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Provider Business Mailing Address
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Address Line | 111 E ALDEN AVE
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City | VALDOSTA
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State | GA
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Zip | 31602-2969
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Country | US
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Telephone | 229-412-1307
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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 | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | OT009399
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License Number State | GA
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