Provider Demographics
NPI:1609382142
Name:THOMAS, CAROLYN GRACE (MS, L-ATC)
Entity type:Individual
Prefix:MRS
First Name:CAROLYN
Middle Name:GRACE
Last Name:THOMAS
Suffix:
Gender:F
Credentials:MS, L-ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1516 HICKORY WOOD DR
Mailing Address - Street 2:
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21409-5435
Mailing Address - Country:US
Mailing Address - Phone:908-432-3971
Mailing Address - Fax:
Practice Address - Street 1:8483 PAINT BRANCH RD
Practice Address - Street 2:
Practice Address - City:COLLEGE PARK
Practice Address - State:MD
Practice Address - Zip Code:20742-8053
Practice Address - Country:US
Practice Address - Phone:202-699-1655
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-20
Last Update Date:2024-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA00012852255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer