Individual
JONATHAN TYLER THAMES
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
COTA/L
Contact information
Practice address
350 GETWELL ST, MARKS, MS 38646-9785
(662) 326-3690
Mailing address
3261 MAGNOLIA BLOOM DR, HERNANDO, MS 38632-2463
(601) 270-7160
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
TA2418
MS
Other
Enumeration date
05/05/2020
Last updated
05/05/2020
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