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General NPI Number Information
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NPI Number | 1417482332
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Entity Type | Individual
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Provider Name | THOMAS ANTHONY PAVER III OTR/L
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Gender | Male
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Dates
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Enumeration Date | 04/28/2017
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Last Update Date | 03/03/2023
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Provider Practice Location Address
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Address Line | 721 W MULBERRY ST
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City | ANGLETON
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State | TX
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Zip | 77515-4239
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Country | US
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Telephone | 979-529-8321
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Fax |
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Provider Business Mailing Address
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Address Line | 201 HACKBERRY ST APT 413
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City | CLUTE
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State | TX
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Zip | 77531-3904
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Country | US
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Telephone | 979-529-8321
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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 | 110004
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License Number State | TX
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