Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | A01644 | MD |
NPI | 1033382163 |
---|---|
Provider Name | Mebune Thomas |
First Address | Laurel, MD 20708-4213 |
Second Address | Laurel, MD 20708-4213 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/04/2008 |
Last Update Date | 09/04/2008 |