Provider Demographics
NPI:1831640796
Name:THOMAS, ERIK TREVOR (MOT)
Entity type:Individual
Prefix:
First Name:ERIK
Middle Name:TREVOR
Last Name:THOMAS
Suffix:
Gender:M
Credentials:MOT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12366 CORPORAL CIR
Mailing Address - Street 2:
Mailing Address - City:PORT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33953-2259
Mailing Address - Country:US
Mailing Address - Phone:941-661-1586
Mailing Address - Fax:
Practice Address - Street 1:12366 CORPORAL CIR
Practice Address - Street 2:
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33953-2259
Practice Address - Country:US
Practice Address - Phone:941-661-1586
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-17
Last Update Date:2016-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL7320225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist