Individual
CHEVELLE THOMAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1167 W BALTIMORE PIKE # 258, MEDIA, PA 19063-5127
(484) 577-9928
Mailing address
151 S BISHOP AVE APT P109, SECANE, PA 19018-1965
(610) 609-4238
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
PA
Other
Enumeration date
10/28/2020
Last updated
10/28/2020
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