Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XM0800X | Mental Health | 3536 | AL |
N | 225XP0019X | Occupational Therapist - Physical Rehabilitation | 3536 | AL |
NPI | 1902262702 |
---|---|
Provider Name | Thomas George Gleason |
First Address | Birmingham, AL 35246-0001 |
Second Address | Birmingham, AL 35246-0001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/01/2016 |
Last Update Date | 08/01/2016 |