Provider Demographics
NPI:1346580073
Name:LOWELL, THOMAS PATRICK (OTA 11142)
Entity Type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:PATRICK
Last Name:LOWELL
Suffix:
Gender:M
Credentials:OTA 11142
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:380 WICKHAM LAKES DR
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32940-2209
Mailing Address - Country:US
Mailing Address - Phone:321-614-4235
Mailing Address - Fax:
Practice Address - Street 1:380 WICKHAM LAKES DR
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32940-2209
Practice Address - Country:US
Practice Address - Phone:321-614-4235
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-16
Last Update Date:2013-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11142224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant