MEDICARE: LOVER S THOMAS

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	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1891265229
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LOVER S THOMAS

Provider Business Mailing Address
First Line	:	175 MIDDLE ST UNIT 1201
Second Line	:
City	:	LAKE MARY
State	:	FL
Zip	:	32746-3625
Country	:	US
Telephone Number	:	866-610-0580
Fax Number	:

Provider Business Practice Location Address
First Line	:	1260 UPPER HEMBREE RD STE D
Second Line	:
City	:	ROSWELL
State	:	GA
Zip	:	30076-4611
Country	:	US
Telephone Number	:	866-610-0580
Fax Number	:

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

Provider Enumeration Date	:	11/28/2018
Last Update Date	:	11/28/2018

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Directions to “ LOVER S THOMAS ” Practice Location

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