Provider Demographics
NPI:1447769245
Name:THOMAS, BRITTANY NICOLE (COTA)
Entity Type:Individual
Prefix:
First Name:BRITTANY
Middle Name:NICOLE
Last Name:THOMAS
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20921 NANTICOKE RD
Mailing Address - Street 2:
Mailing Address - City:BIVALVE
Mailing Address - State:MD
Mailing Address - Zip Code:21814-2019
Mailing Address - Country:US
Mailing Address - Phone:410-957-2252
Mailing Address - Fax:
Practice Address - Street 1:1006 MARKET ST
Practice Address - Street 2:
Practice Address - City:POCOMOKE CITY
Practice Address - State:MD
Practice Address - Zip Code:21851-1206
Practice Address - Country:US
Practice Address - Phone:410-957-2252
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-25
Last Update Date:2017-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD362320224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant