Provider Demographics
NPI:1275878928
Name:LASTER, THOMAS EVANS (OTR)
Entity Type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:EVANS
Last Name:LASTER
Suffix:
Gender:M
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5912 OKEECHOBEE BLVD
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33417-4324
Mailing Address - Country:US
Mailing Address - Phone:561-697-8800
Mailing Address - Fax:561-697-3372
Practice Address - Street 1:5912 OKEECHOBEE BLVD
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33417-4324
Practice Address - Country:US
Practice Address - Phone:561-697-8800
Practice Address - Fax:561-697-3372
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-06
Last Update Date:2012-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT 14333225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist