Provider Demographics
NPI:1497517833
Name:THOMAS, JACLYN SUZANNE
Entity Type:Individual
Prefix:
First Name:JACLYN
Middle Name:SUZANNE
Last Name:THOMAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:904 OAK AVE N
Mailing Address - Street 2:
Mailing Address - City:ONALASKA
Mailing Address - State:WI
Mailing Address - Zip Code:54650-2188
Mailing Address - Country:US
Mailing Address - Phone:608-386-1035
Mailing Address - Fax:
Practice Address - Street 1:904 OAK AVE N
Practice Address - Street 2:
Practice Address - City:ONALASKA
Practice Address - State:WI
Practice Address - Zip Code:54650-2188
Practice Address - Country:US
Practice Address - Phone:608-386-1035
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-30
Last Update Date:2024-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer