Provider Demographics
NPI:1770897894
Name:TRINIDAD, THOMAS J (OT)
Entity type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:J
Last Name:TRINIDAD
Suffix:
Gender:M
Credentials:OT
Other - Prefix:MR
Other - First Name:TOM
Other - Middle Name:J
Other - Last Name:TRINIDAD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OT
Mailing Address - Street 1:17 SLEEPYWOOD CV
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:TN
Mailing Address - Zip Code:38305-8778
Mailing Address - Country:US
Mailing Address - Phone:731-664-7013
Mailing Address - Fax:
Practice Address - Street 1:2400 E MITCHELL ST
Practice Address - Street 2:
Practice Address - City:HUMBOLDT
Practice Address - State:TN
Practice Address - Zip Code:38343-3036
Practice Address - Country:US
Practice Address - Phone:731-784-5183
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-30
Last Update Date:2010-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN917225X00000X, 225XG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XG0600XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGerontology