Provider Demographics
NPI:1205633211
Name:THOMAS, FRED A SR (MA)
Entity type:Individual
Prefix:MR
First Name:FRED
Middle Name:A
Last Name:THOMAS
Suffix:SR
Gender:
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1991 HEATHCLIFF DR APT 2B
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43209-3429
Mailing Address - Country:US
Mailing Address - Phone:614-397-0728
Mailing Address - Fax:
Practice Address - Street 1:1991 HEATHCLIFF DR APT 2B
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43209-3429
Practice Address - Country:US
Practice Address - Phone:614-397-0728
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-26
Last Update Date:2025-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH320700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320700000XResidential Treatment FacilitiesResidential Treatment Facility, Physical Disabilities