MEDICARE: DETRA S THOMAS

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	372600000X	Adult Companion
2	172A00000X	Driver
3	253Z00000X	In Home Supportive Care Agency
4	347C00000X	Private Vehicle

General Provider Information

NPI Number	:	1104670629
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DETRA S THOMAS

Provider Business Mailing Address
First Line	:	497 BACON AVE
Second Line	:
City	:	AKRON
State	:	OH
Zip	:	44320-2157
Country	:	US
Telephone Number	:	330-410-0600
Fax Number	:

Provider Business Practice Location Address
First Line	:	497 BACON AVE
Second Line	:
City	:	AKRON
State	:	OH
Zip	:	44320-2157
Country	:	US
Telephone Number	:	330-410-0600
Fax Number	:

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

Provider Enumeration Date	:	04/11/2024
Last Update Date	:	04/11/2024

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Directions to “ DETRA S THOMAS ” Practice Location

Language	Start Address	Practice Location

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