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Individual

TABATHA THOMAS

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
OT LIMITED PERMIT

Contact information

Practice address
250 S NEW FLORISSANT RD, FLORISSANT, MO 63031-6716
(314) 838-2211
Mailing address
6042 PERSHING AVE, APT. A, SAINT LOUIS, MO 63112-1310
(731) 415-1794

Taxonomy

Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
2012026278
MO

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
2012026278
STATE OF MISSOURI, MISSOURI BOARD OF HEALING ARTS
MO
Enumeration date
10/24/2012
Last updated
10/24/2012
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