Provider Demographics
NPI:1396027934
Name:THOMAS, ANTONIA PATRICIA (OTR/L, BCBA)
Entity Type:Individual
Prefix:MISS
First Name:ANTONIA
Middle Name:PATRICIA
Last Name:THOMAS
Suffix:
Gender:F
Credentials:OTR/L, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:520 NW 165TH STREET RD STE 205
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33169-6343
Mailing Address - Country:US
Mailing Address - Phone:786-805-6454
Mailing Address - Fax:800-397-0061
Practice Address - Street 1:520 NW 165TH STREET RD STE 205
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33169-6343
Practice Address - Country:US
Practice Address - Phone:786-805-6454
Practice Address - Fax:800-397-0061
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-09
Last Update Date:2024-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT14727225X00000X
103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist