Provider Demographics
NPI:1891219366
Name:OKELLY, THOMAS (LAT, ATC)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:
Last Name:OKELLY
Suffix:
Gender:M
Credentials:LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1551 ATRIA CIR APT 2302
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27604-5332
Mailing Address - Country:US
Mailing Address - Phone:484-844-0167
Mailing Address - Fax:
Practice Address - Street 1:1551 ATRIA CIR APT 2302
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27604-5332
Practice Address - Country:US
Practice Address - Phone:484-844-0167
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-26
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCLAT-31832255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic TrainerGroup - Single Specialty