Provider Demographics
NPI:1003468828
Name:THOMASON, VICTORIA L
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:L
Last Name:THOMASON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5750 DTC PKWY STE 170
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD VILLAGE
Mailing Address - State:CO
Mailing Address - Zip Code:80111-5483
Mailing Address - Country:US
Mailing Address - Phone:303-504-9945
Mailing Address - Fax:303-504-9946
Practice Address - Street 1:5750 DTC PKWY STE 170
Practice Address - Street 2:
Practice Address - City:GREENWOOD VILLAGE
Practice Address - State:CO
Practice Address - Zip Code:80111-5483
Practice Address - Country:US
Practice Address - Phone:303-504-9945
Practice Address - Fax:303-504-9946
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-11
Last Update Date:2019-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO9000142570Medicaid