Provider Demographics
NPI:1114407095
Name:THOMAS, IRENE (CTRS)
Entity Type:Individual
Prefix:
First Name:IRENE
Middle Name:
Last Name:THOMAS
Suffix:
Gender:F
Credentials:CTRS
Other - Prefix:MS
Other - First Name:IRENE
Other - Middle Name:
Other - Last Name:THOMAS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CTRS
Mailing Address - Street 1:3701 LOOP ROAD
Mailing Address - Street 2:RECREATION THERAPY DEPARTMENT
Mailing Address - City:TUSCALOOSA
Mailing Address - State:AL
Mailing Address - Zip Code:35404
Mailing Address - Country:US
Mailing Address - Phone:205-554-2000
Mailing Address - Fax:
Practice Address - Street 1:3701 LOOP ROAD
Practice Address - Street 2:RECREATION THERAPY DEPARTMENT
Practice Address - City:TUSCALOOSA
Practice Address - State:AL
Practice Address - Zip Code:35404
Practice Address - Country:US
Practice Address - Phone:205-554-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-20
Last Update Date:2018-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL27356225800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRecreation Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL27356OtherNCTRC