Provider Demographics
NPI:1093494650
Name:THOMAS, MISHAYLA
Entity Type:Individual
Prefix:
First Name:MISHAYLA
Middle Name:
Last Name:THOMAS
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:GREENFIELD REHAB GREEN BAY
Mailing Address - Street 2:225 S. MONROE AVE #201
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:53045
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:GREENFIELD REHAB GREEN BAY
Practice Address - Street 2:225 S. MONROE AVE #201
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:53045
Practice Address - Country:US
Practice Address - Phone:262-295-6289
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-12
Last Update Date:2023-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist