=====================================================
General NPI Number Information
=====================================================
NPI Number | 1649482357
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JAMIE CAROLINE THOMAS OTR
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/04/2007
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | SUPPLEMENTAL HEALTH CARE 9441 LBJ FREEWAY #101
-----------------------------------------------------
City | DALLAS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75243
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 972-575-9820
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 529 FAIRVIEW
-----------------------------------------------------
City | RICHARDSON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75081
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 972-658-5599
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225X00000X
-----------------------------------------------------
Taxonomy Name | Occupational Therapist
-----------------------------------------------------
License Number | 109529
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------