MEDICARE: KEVIN LOWELL JAMES THOMASON

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	:	1962344960
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KEVIN LOWELL JAMES THOMASON

Provider Business Mailing Address
First Line	:	818 NORTH BLVD
Second Line	:
City	:	OAK PARK
State	:	IL
Zip	:	60301-1302
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3101 SUPERIOR DR NW
Second Line	:
City	:	ROCHESTER
State	:	MN
Zip	:	55901-1993
Country	:	US
Telephone Number	:	507-292-1006
Fax Number	:

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

Provider Enumeration Date	:	04/08/2026
Last Update Date	:	04/08/2026

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