Provider Demographics
NPI:1821732439
Name:FEY, THOMAS SEBASTIAN
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:SEBASTIAN
Last Name:FEY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1818 JOSEPHINE ST
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33815-3922
Mailing Address - Country:US
Mailing Address - Phone:813-305-9237
Mailing Address - Fax:
Practice Address - Street 1:1818 JOSEPHINE ST
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33815-3922
Practice Address - Country:US
Practice Address - Phone:813-305-9237
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-21
Last Update Date:2022-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician