Provider Demographics
NPI:1013290519
Name:GAZAWAY, THOMAS HAVEN (OT)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:HAVEN
Last Name:GAZAWAY
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 1:2015 HIGHPOINTE DRIVE
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:MS
Mailing Address - Zip Code:39042-0000
Mailing Address - Country:US
Mailing Address - Phone:888-976-2667
Mailing Address - Fax:601-824-8816
Practice Address - Street 1:2015 HIGHPOINTE DRIVE
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:MS
Practice Address - Zip Code:39042-0000
Practice Address - Country:US
Practice Address - Phone:888-976-2667
Practice Address - Fax:601-824-8816
Is Sole Proprietor?:No
Enumeration Date:2011-09-21
Last Update Date:2011-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSOT2580225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist