Provider Demographics
NPI:1073273132
Name:THOMASON, MACIE RAYE
Entity Type:Individual
Prefix:
First Name:MACIE
Middle Name:RAYE
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 1:100 OAKDALE DR
Mailing Address - Street 2:
Mailing Address - City:RUSSELLVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42276-8876
Mailing Address - Country:US
Mailing Address - Phone:270-893-8271
Mailing Address - Fax:
Practice Address - Street 1:100 OAKDALE DR
Practice Address - Street 2:
Practice Address - City:RUSSELLVILLE
Practice Address - State:KY
Practice Address - Zip Code:42276-8876
Practice Address - Country:US
Practice Address - Phone:270-893-8271
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-29
Last Update Date:2021-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist