Provider Demographics
NPI:1144825670
Name:THOMAS, TAYLOR C (MSOT)
Entity type:Individual
Prefix:
First Name:TAYLOR
Middle Name:C
Last Name:THOMAS
Suffix:
Gender:F
Credentials:MSOT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7500 MARLBORO PIKE STE A
Mailing Address - Street 2:
Mailing Address - City:FORESTVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20747-4311
Mailing Address - Country:US
Mailing Address - Phone:240-619-4980
Mailing Address - Fax:
Practice Address - Street 1:5801 ALLENTOWN RD STE 410
Practice Address - Street 2:
Practice Address - City:CAMP SPRINGS
Practice Address - State:MD
Practice Address - Zip Code:20746-4565
Practice Address - Country:US
Practice Address - Phone:301-238-4788
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-02
Last Update Date:2020-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD09057225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist