Provider Demographics
NPI:1598919953
Name:THOMAS, JUDITH PEARL
Entity Type:Individual
Prefix:MRS
First Name:JUDITH
Middle Name:PEARL
Last Name:THOMAS
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:JUDY
Other - Middle Name:PEARL
Other - Last Name:THOMAS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:11346 S RENEE AVE
Mailing Address - Street 2:
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85367-5717
Mailing Address - Country:US
Mailing Address - Phone:928-342-9033
Mailing Address - Fax:928-342-9033
Practice Address - Street 1:2470 S ARIZONA AVE
Practice Address - Street 2:
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85364-8520
Practice Address - Country:US
Practice Address - Phone:928-344-8541
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-11-12
Last Update Date:2008-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1463224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant