Provider Demographics
NPI:1538050950
Name:TICE, THOMAS MARION
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:MARION
Last Name:TICE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4481 VALLEY VIEW DR
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:KY
Mailing Address - Zip Code:41101-6215
Mailing Address - Country:US
Mailing Address - Phone:606-232-5019
Mailing Address - Fax:
Practice Address - Street 1:208 4TH ST E
Practice Address - Street 2:
Practice Address - City:SOUTH POINT
Practice Address - State:OH
Practice Address - Zip Code:45680-9430
Practice Address - Country:US
Practice Address - Phone:740-451-0307
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-14
Last Update Date:2025-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator