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General NPI Number Information
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NPI Number | 1306404256
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Entity Type | Individual
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Provider Name | MISTY CORTES-THOMAS OTR/L
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Gender | Female
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Dates
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Enumeration Date | 06/04/2019
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Last Update Date | 03/09/2022
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Provider Practice Location Address
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Address Line | 4410 GULF BREEZE PKWY
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City | GULF BREEZE
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State | FL
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Zip | 32563-8130
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Country | US
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Telephone | 859-492-1273
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Fax |
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Provider Business Mailing Address
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Address Line | 417 WHITE OAK DR
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City | HINDMAN
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State | KY
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Zip | 41822-8773
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Country | US
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Telephone |
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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 | 5527
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License Number State | SC
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Taxonomy #2
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | OT21401
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License Number State | FL
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