Basic Information
| Provider Information | |||||||||
| NPI: | 1598249583 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LEWIS | ||||||||
| FirstName: | THOMAS | ||||||||
| MiddleName: | VERNON | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1355 MORGAN WAY APT 208 | ||||||||
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| City: | WINSTON SALEM | ||||||||
| State: | NC | ||||||||
| PostalCode: | 271275154 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3042766508 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2500 POLO RIDGE CT | ||||||||
| Address2: | |||||||||
| City: | WINSTON SALEM | ||||||||
| State: | NC | ||||||||
| PostalCode: | 271063950 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3367227118 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/17/2018 | ||||||||
| LastUpdateDate: | 04/12/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 04/12/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | 11174 | NC | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
No ID Information.