Provider Demographics
NPI:1801163837
Name:THOMAS, KATHY ELLEN (AP, MSOM)
Entity type:Individual
Prefix:MRS
First Name:KATHY
Middle Name:ELLEN
Last Name:THOMAS
Suffix:
Gender:F
Credentials:AP, MSOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:351 PLAZA DR
Mailing Address - Street 2:
Mailing Address - City:EUSTIS
Mailing Address - State:FL
Mailing Address - Zip Code:32726-6558
Mailing Address - Country:US
Mailing Address - Phone:352-323-0795
Mailing Address - Fax:352-323-0693
Practice Address - Street 1:351 PLAZA DR.
Practice Address - Street 2:
Practice Address - City:EUSTIS
Practice Address - State:FL
Practice Address - Zip Code:32726-3963
Practice Address - Country:US
Practice Address - Phone:352-323-0795
Practice Address - Fax:352-323-0693
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-18
Last Update Date:2013-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP3009171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist