Provider Demographics
NPI:1053869941
Name:THOMAS, TIA
Entity type:Individual
Prefix:
First Name:TIA
Middle Name:
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 1:1206 BRANDYWINE BLVD
Mailing Address - Street 2:SUITE E
Mailing Address - City:ZANESVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43701-1755
Mailing Address - Country:US
Mailing Address - Phone:877-430-5611
Mailing Address - Fax:
Practice Address - Street 1:1206 BRANDYWINE BLVD
Practice Address - Street 2:SUITE E
Practice Address - City:ZANESVILLE
Practice Address - State:OH
Practice Address - Zip Code:43701-1755
Practice Address - Country:US
Practice Address - Phone:877-430-5611
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-20
Last Update Date:2016-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH81-2277052332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies