MEDICARE: MRS. ANGEL LEE THOMAS OTR/L

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	OT009190	OH

General Provider Information

NPI Number	:	1669934071
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ANGEL LEE THOMAS OTR/L

Provider Business Mailing Address
First Line	:	408 HERITAGE AVE
Second Line	:
City	:	CANAL FULTON
State	:	OH
Zip	:	44614-1235
Country	:	US
Telephone Number	:	724-600-6371
Fax Number	:

Provider Business Practice Location Address
First Line	:	401 SNYDER AVE
Second Line	:
City	:	BARBERTON
State	:	OH
Zip	:	44203-4131
Country	:	US
Telephone Number	:	724-600-6371
Fax Number	:

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

Provider Enumeration Date	:	04/03/2019
Last Update Date	:	04/03/2019

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