Provider Demographics
NPI:1154395515
Name:THOMAS, JAQUELINE KOKE (MOT, OTR/L)
Entity type:Individual
Prefix:MRS
First Name:JAQUELINE
Middle Name:KOKE
Last Name:THOMAS
Suffix:
Gender:F
Credentials:MOT, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7803 NE 72ND TER
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64158-1268
Mailing Address - Country:US
Mailing Address - Phone:816-415-9399
Mailing Address - Fax:
Practice Address - Street 1:7803 NE 72ND TER
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64158-1268
Practice Address - Country:US
Practice Address - Phone:816-756-0780
Practice Address - Fax:816-756-1677
Is Sole Proprietor?:No
Enumeration Date:2006-02-14
Last Update Date:2009-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO003592225XP0200X, 225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO478149826Medicaid