MEDICARE: THOMAS HAVEN GAZAWAY OT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist	OT2580	MS

General Provider Information

NPI Number	:	1013290519
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THOMAS HAVEN GAZAWAY OT

Provider Business Mailing Address
First Line	:	2015 HIGHPOINTE DRIVE
Second Line	:
City	:	BRANDON
State	:	MS
Zip	:	39042-0000
Country	:	US
Telephone Number	:	888-976-2667
Fax Number	:	601-824-8816

Provider Business Practice Location Address
First Line	:	2015 HIGHPOINTE DRIVE
Second Line	:
City	:	BRANDON
State	:	MS
Zip	:	39042-0000
Country	:	US
Telephone Number	:	888-976-2667
Fax Number	:	601-824-8816

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/21/2011
Last Update Date	:	09/21/2011

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