Provider Demographics
NPI:1013215094
Name:RICHARDSON, THOMAS ANTHONY (COTA)
Entity Type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:ANTHONY
Last Name:RICHARDSON
Suffix:
Gender:M
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9699 N WANDA CT
Mailing Address - Street 2:
Mailing Address - City:MOORESVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46158-6131
Mailing Address - Country:US
Mailing Address - Phone:317-834-4929
Mailing Address - Fax:
Practice Address - Street 1:8900 KEYSTONE XING STE 600
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46240-2131
Practice Address - Country:US
Practice Address - Phone:317-218-0654
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-01
Last Update Date:2011-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN32001033A224ZE0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224ZE0001XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy AssistantEnvironmental Modification