MEDICARE: THOMAS W FRAZIER PHD INC

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	103TC0700X	Clinical Psychologist	3126	OH

General Provider Information

NPI Number	:	1497064638
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THOMAS W FRAZIER PHD INC

Provider Business Mailing Address
First Line	:	48 ALPHA PARK
Second Line	:
City	:	HIGHLAND HEIGHTS
State	:	OH
Zip	:	44143-2208
Country	:	US
Telephone Number	:	440-461-4249
Fax Number	:	440-461-4246

Provider Business Practice Location Address
First Line	:	48 ALPHA PARK
Second Line	:
City	:	HIGHLAND HEIGHTS
State	:	OH
Zip	:	44143-2208
Country	:	US
Telephone Number	:	440-461-4249
Fax Number	:	440-461-4246

Authorized Official
Title or Position	:	SECRETARY
Name	:	MRS. THERESA M FRAZIER
Credential	:
Telephone Number	:	440-461-4249

Provider Enumeration Date	:	10/06/2010
Last Update Date	:	10/06/2010

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