Provider Demographics
NPI:1972595411
Name:THOMAS, CYNTHIA D (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:CYNTHIA
Middle Name:D
Last Name:THOMAS
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:CYNTHIA
Other - Middle Name:D
Other - Last Name:KELLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:16 WINEBERRY DR
Mailing Address - Street 2:
Mailing Address - City:MECHANICSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17055-5670
Mailing Address - Country:US
Mailing Address - Phone:717-576-2739
Mailing Address - Fax:
Practice Address - Street 1:16 WINEBERRY DR
Practice Address - Street 2:
Practice Address - City:MECHANICSBURG
Practice Address - State:PA
Practice Address - Zip Code:17055-5670
Practice Address - Country:US
Practice Address - Phone:717-576-2739
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-19
Last Update Date:2008-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC004875L225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1537903OtherGATEWAY
PA7653502OtherAETNA PPO/POS
PA20039493OtherAMERIHEALTH MERCY
PA50024082OtherCAPITAL BLUE CROSS
PA074668Medicare ID - Type Unspecified