Provider Demographics
NPI:1629598263
Name:THOMAS, COLLEEN (MT-BC)
Entity Type:Individual
Prefix:
First Name:COLLEEN
Middle Name:
Last Name:THOMAS
Suffix:
Gender:F
Credentials:MT-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1185 LODGE POLE LN
Mailing Address - Street 2:
Mailing Address - City:NORMAL
Mailing Address - State:IL
Mailing Address - Zip Code:61761-9396
Mailing Address - Country:US
Mailing Address - Phone:309-533-5711
Mailing Address - Fax:
Practice Address - Street 1:1185 LODGE POLE LN
Practice Address - Street 2:
Practice Address - City:NORMAL
Practice Address - State:IL
Practice Address - Zip Code:61761-9396
Practice Address - Country:US
Practice Address - Phone:309-533-5711
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-25
Last Update Date:2017-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist