Individual
MRS. MARY E THOMSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CERTIFIED FITTER FOR
Contact information
Practice address
173 CHERRY OAK TRAIL, PETAL, MS 39465
(601) 543-0268
Mailing address
173 CHERRY OAK TRAIL, PETAL, MS 39465
(601) 543-0268
Taxonomy
Speciality
Code
Description
License number
State
225000000X
Orthotic Fitter
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0440560
—
MS
Enumeration date
12/08/2006
Last updated
07/08/2007
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