Provider Demographics
NPI:1902262702
Name:GLEASON, THOMAS GEORGE (OTR/L)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:GEORGE
Last Name:GLEASON
Suffix:
Gender:M
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1713 6TH AVE S
Mailing Address - Street 2:RM C483
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35246-0001
Mailing Address - Country:US
Mailing Address - Phone:205-934-5113
Mailing Address - Fax:205-996-4443
Practice Address - Street 1:1713 6TH AVE S
Practice Address - Street 2:RM C483
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35246-0001
Practice Address - Country:US
Practice Address - Phone:205-934-5113
Practice Address - Fax:205-996-4443
Is Sole Proprietor?:No
Enumeration Date:2016-01-08
Last Update Date:2016-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL3536225XM0800X, 225XP0019X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XM0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistMental Health
No225XP0019XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPhysical Rehabilitation