Provider Demographics
NPI:1831886753
Name:THOMAS, REBECCA
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:THOMAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5770 OLD STATE RD
Mailing Address - Street 2:
Mailing Address - City:GUSTON
Mailing Address - State:KY
Mailing Address - Zip Code:40142-7154
Mailing Address - Country:US
Mailing Address - Phone:270-945-4542
Mailing Address - Fax:
Practice Address - Street 1:5770 OLD STATE RD
Practice Address - Street 2:
Practice Address - City:GUSTON
Practice Address - State:KY
Practice Address - Zip Code:40142-7154
Practice Address - Country:US
Practice Address - Phone:270-945-4542
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-20
Last Update Date:2023-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY201181204222Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist