Provider Demographics
NPI:1386816437
Name:THOMAS, MARY CELESTE (MSOT, OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:CELESTE
Last Name:THOMAS
Suffix:
Gender:F
Credentials:MSOT, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3913 HILLCROSS DR
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40229-2685
Mailing Address - Country:US
Mailing Address - Phone:502-387-8819
Mailing Address - Fax:
Practice Address - Street 1:3913 HILLCROSS DR
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40229-2685
Practice Address - Country:US
Practice Address - Phone:502-387-8819
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-28
Last Update Date:2008-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY-R3149225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist