Provider Demographics
NPI:1740597061
Name:THOMAS, JENNIFER KAY (OTR)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:KAY
Last Name:THOMAS
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:99 REGENCY PKWY
Mailing Address - Street 2:STE 313
Mailing Address - City:MANSFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:76063-7817
Mailing Address - Country:US
Mailing Address - Phone:888-864-3572
Mailing Address - Fax:
Practice Address - Street 1:99 REGENCY PKWY
Practice Address - Street 2:STE 313
Practice Address - City:MANSFIELD
Practice Address - State:TX
Practice Address - Zip Code:76063-7817
Practice Address - Country:US
Practice Address - Phone:888-864-3572
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-08
Last Update Date:2010-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX112263225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist