Provider Demographics
NPI:1902455280
Name:THOMAS, CASEY E
Entity Type:Individual
Prefix:
First Name:CASEY
Middle Name:E
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 1:4745 HORSESHOE CT SE
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97317-5539
Mailing Address - Country:US
Mailing Address - Phone:971-304-8708
Mailing Address - Fax:
Practice Address - Street 1:4745 HORSESHOE CT SE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97317-5539
Practice Address - Country:US
Practice Address - Phone:971-304-8708
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-09
Last Update Date:2019-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR3747A0650X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR3747A0650XOtherDEPARTMENT OF VETERIAN AFFAIRS PAYMENT CENTER