Provider Demographics
NPI:1982935797
Name:THOMAS, MARK WARREN (COTA/L)
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:WARREN
Last Name:THOMAS
Suffix:
Gender:M
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:5186 ELPINE WAY
Mailing Address - Street 2:
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33418-7848
Mailing Address - Country:US
Mailing Address - Phone:561-602-3867
Mailing Address - Fax:561-963-3441
Practice Address - Street 1:2792 DONNELLY DR
Practice Address - Street 2:
Practice Address - City:LANTANA
Practice Address - State:FL
Practice Address - Zip Code:33462-6431
Practice Address - Country:US
Practice Address - Phone:561-602-3867
Practice Address - Fax:561-963-3441
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-18
Last Update Date:2010-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOTA8903224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant