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NPI Code Detail

MEDICARE: MR. JOHN DARRYL THOMANDER OTA

MEDICARE: MR. JOHN DARRYL THOMANDER OTA
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
1224Z00000XOccupational Therapy Assistant1343CA

General Provider Information

NPI Number : 1952743551
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. JOHN DARRYL THOMANDER OTA
Provider Business Mailing Address
First Line : 3651 7TH AVE
Second Line :
City : SACRAMENTO
State : CA
Zip : 95817-3220
Country : US
Telephone Number : 916-677-9399
Fax Number :
Provider Business Practice Location Address
First Line : 3900 GARFIELD AVE
Second Line :
City : CARMICHAEL
State : CA
Zip : 95608-6647
Country : US
Telephone Number : 916-481-6455
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/23/2013
Last Update Date : 07/25/2013

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