Provider Demographics
NPI:1487874939
Name:THOMAS, COLLEEN TERESA
Entity type:Individual
Prefix:
First Name:COLLEEN
Middle Name:TERESA
Last Name:THOMAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3334 ROBIN RD
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40213-1336
Mailing Address - Country:US
Mailing Address - Phone:502-235-8927
Mailing Address - Fax:502-448-2618
Practice Address - Street 1:3334 ROBIN RD
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40213-1336
Practice Address - Country:US
Practice Address - Phone:502-235-8927
Practice Address - Fax:502-448-2618
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-26
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
222Q00000X
KYKY-R3651225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist