Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | AL |
NPI | 1003589920 |
---|---|
Provider Name | Gabrielle Martinique Thomas |
First Address | Wetumpka, AL 36092-2113 |
Second Address | Alexander City, AL 35010-4800 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/07/2021 |
Last Update Date | 27/07/2021 |