Provider Demographics
NPI:1821282716
Name:THOMAS, DAVID SCOTT (CO OTC)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:SCOTT
Last Name:THOMAS
Suffix:
Gender:M
Credentials:CO OTC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3700 BRAINERD RD
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37411-3603
Mailing Address - Country:US
Mailing Address - Phone:423-697-0057
Mailing Address - Fax:423-648-9366
Practice Address - Street 1:2400 E ANDREW JOHNSON HWY
Practice Address - Street 2:
Practice Address - City:GREENEVILLE
Practice Address - State:TN
Practice Address - Zip Code:37745-0948
Practice Address - Country:US
Practice Address - Phone:423-525-5073
Practice Address - Fax:423-525-5349
Is Sole Proprietor?:No
Enumeration Date:2007-09-04
Last Update Date:2010-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNC16007222Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist
Provider Identifiers
StateIdentifier IDID TypeIssuer
C16007OtherBOC
TN1455062Medicaid
IO2135OtherINT'L ASSOC. FOR ORTHOTIS
TN1507472Medicaid
TN1455062Medicaid
IO2135OtherINT'L ASSOC. FOR ORTHOTIS