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General NPI Number Information
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NPI Number | 1497180962
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Entity Type | Organization
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Legal Business Name | CLAY & LORRI THOMAS
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Dates
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Enumeration Date | 09/03/2013
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Last Update Date | 09/03/2013
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Provider Practice Location Address
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Address Line | 27105 HIGHWAY 62
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City | TRAIL
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State | OR
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Zip | 97541-9771
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Country | US
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Telephone | 541-878-2975
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Fax |
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Provider Business Mailing Address
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Address Line | 27105 HIGHWAY 62
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City | TRAIL
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State | OR
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Zip | 97541-9771
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Country | US
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Telephone | 541-878-2975
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Fax |
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Authorized Official
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Title or Position | FOSTER PARENT
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Name | CLAY THOMAS
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Credential | 5418782975
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Telephone | 541-878-2975
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 385HR2065X
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Taxonomy Name | Child Physical Disabilities Respite Care
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License Number |
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License Number State |
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