Provider Demographics
NPI:1255939682
Name:THOMAS, AMY (LCAT, MT-BC)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:THOMAS
Suffix:
Gender:F
Credentials:LCAT, MT-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4688 E WILLIAMSON RD
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:NY
Mailing Address - Zip Code:14505-9330
Mailing Address - Country:US
Mailing Address - Phone:585-750-1156
Mailing Address - Fax:
Practice Address - Street 1:401 PENBROOKE DR
Practice Address - Street 2:BUILDING 3
Practice Address - City:PENFIELD
Practice Address - State:NY
Practice Address - Zip Code:14526-2041
Practice Address - Country:US
Practice Address - Phone:585-377-1000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-16
Last Update Date:2020-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000771221700000X, 225A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist
No221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt Therapist