=====================================================
General NPI Number Information
=====================================================
NPI Number | 1487822789
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MARGIE A. THOMAS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/20/2008
-----------------------------------------------------
Last Update Date | 07/24/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1386 VILLAGE WAY APT 508
-----------------------------------------------------
City | FREMONT
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43420-3241
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 440-320-6496
-----------------------------------------------------
Fax | 419-334-5881
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1386 VILLAGE WAY #508
-----------------------------------------------------
City | FREMONT
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43420
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 567-201-0424
-----------------------------------------------------
Fax | 419-334-5881
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | NURSE PROVIDER
-----------------------------------------------------
Name | MS. MARGIE A. THOMAS
-----------------------------------------------------
Credential | LPN
-----------------------------------------------------
Telephone | 567-201-0424
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 313M00000X
-----------------------------------------------------
Taxonomy Name | Nursing Facility/Intermediate Care Facility
-----------------------------------------------------
License Number | PN-086542
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------