Provider Demographics
NPI:1639286008
Name:THOMAS, JOHN D (OT)
Entity Type:Individual
Prefix:PROF
First Name:JOHN
Middle Name:D
Last Name:THOMAS
Suffix:
Gender:M
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:161 CHRISTIAN DR
Mailing Address - Street 2:
Mailing Address - City:RAYVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:71269-3658
Mailing Address - Country:US
Mailing Address - Phone:318-728-3665
Mailing Address - Fax:318-728-3625
Practice Address - Street 1:161 CHRISTIAN DR
Practice Address - Street 2:
Practice Address - City:RAYVILLE
Practice Address - State:LA
Practice Address - Zip Code:71269-3658
Practice Address - Country:US
Practice Address - Phone:318-728-3665
Practice Address - Fax:318-728-3625
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAZ11123225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LAZ11123OtherOT LICENSE
LA4H584CR61Medicare ID - Type UnspecifiedMEDICARE PROVIDER#