Provider Demographics
NPI:1528591039
Name:THOMAS, SHANTINA DOLLMESHIA (COTA/L)
Entity Type:Individual
Prefix:MS
First Name:SHANTINA
Middle Name:DOLLMESHIA
Last Name:THOMAS
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6352 CADBURY LN
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36116-4349
Mailing Address - Country:US
Mailing Address - Phone:863-651-1961
Mailing Address - Fax:
Practice Address - Street 1:6352 CADBURY LN
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36116-4349
Practice Address - Country:US
Practice Address - Phone:863-651-1961
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-11
Last Update Date:2017-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL4065224Z00000X
FL11615224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant