Provider Demographics
NPI:1134165400
Name:THAMES, WILL (OTR)
Entity type:Individual
Prefix:MR
First Name:WILL
Middle Name:
Last Name:THAMES
Suffix:
Gender:M
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 242187
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36124-2187
Mailing Address - Country:US
Mailing Address - Phone:334-396-3273
Mailing Address - Fax:334-396-4905
Practice Address - Street 1:6715 TAYLOR CT
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36117-7708
Practice Address - Country:US
Practice Address - Phone:334-396-2110
Practice Address - Fax:334-396-2115
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2010-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1138225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51523719OtherBLUE CROSS & BLUE SHIELD
AL515-23720OtherBLUR CROSS & BLUE SHIELD
Q21197Medicare UPIN
AL51523719OtherBLUE CROSS & BLUE SHIELD