Provider Demographics
NPI:1427345602
Name:THOMAS, ALLISON (MT-BC)
Entity type:Individual
Prefix:
First Name:ALLISON
Middle Name:
Last Name:THOMAS
Suffix:
Gender:F
Credentials:MT-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5826 LEESVILLE PL
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46835-4468
Mailing Address - Country:US
Mailing Address - Phone:604-098-2462
Mailing Address - Fax:
Practice Address - Street 1:1856 RIVER RUN TRL
Practice Address - Street 2:APT D
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46825-5986
Practice Address - Country:US
Practice Address - Phone:260-409-8246
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-07
Last Update Date:2020-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN09544225A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist