Provider Demographics
NPI:1871075317
Name:THOMAS, HARLEY MARIE (COTA)
Entity type:Individual
Prefix:MISS
First Name:HARLEY
Middle Name:MARIE
Last Name:THOMAS
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 332
Mailing Address - Street 2:
Mailing Address - City:HEMPHILL
Mailing Address - State:TX
Mailing Address - Zip Code:75948-0332
Mailing Address - Country:US
Mailing Address - Phone:936-275-6772
Mailing Address - Fax:
Practice Address - Street 1:1000 FM 3220
Practice Address - Street 2:
Practice Address - City:CLIFTON
Practice Address - State:TX
Practice Address - Zip Code:76634-1034
Practice Address - Country:US
Practice Address - Phone:254-675-2828
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-31
Last Update Date:2018-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX214386224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant