Basic Information
| Provider Information | |||||||||
| NPI: | 1639141294 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | THOMAS | ||||||||
| FirstName: | JERRY | ||||||||
| MiddleName: | KEITH | ||||||||
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| Credential: | O.T.R. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 86 | ||||||||
| Address2: | |||||||||
| City: | HERRIN | ||||||||
| State: | IL | ||||||||
| PostalCode: | 629480086 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6187272211 | ||||||||
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| Practice Location | |||||||||
| Address1: | 201 S 14TH ST | ||||||||
| Address2: | ACUTE REHAB CENTER | ||||||||
| City: | HERRIN | ||||||||
| State: | IL | ||||||||
| PostalCode: | 629483631 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6189422171 | ||||||||
| FaxNumber: | 6183514927 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/07/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225XH1200X | IL | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Hand |
No ID Information.