Individual
MONTINA MARIE THOMAS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
714 SHAMROCK RD, BRANDENBURG, KY 40108-6487
(270) 945-1603
Mailing address
714 SHAMROCK RD, BRANDENBURG, KY 40108-6487
(270) 945-1603
Taxonomy
Speciality
Code
Description
License number
State
222Q00000X
Developmental Therapist
Primary
201126605
KY
Other
Enumeration date
05/28/2011
Last updated
05/28/2011
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