Provider Demographics
NPI:1316240013
Name:MCDERMOTT, THOMAS M (OT/L)
Entity type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:M
Last Name:MCDERMOTT
Suffix:
Gender:M
Credentials:OT/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:241 STARCREST RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22902-8242
Mailing Address - Country:US
Mailing Address - Phone:434-465-1474
Mailing Address - Fax:
Practice Address - Street 1:241 STARCREST RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22902-8242
Practice Address - Country:US
Practice Address - Phone:434-465-1474
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-19
Last Update Date:2010-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0119002119225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist