Mary E Thomsen, CERTIFIED FITTER FOR
Individual provider Active NPI Orthotic Fitter · Petal, MS
NPI 1154480804 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1154480804
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Orthotic Fitter 225000000X
- Practice address
- 173 Cherry Oak Trail
Petal, MS 39465 - Phone
- (601) 543-0268
- NPI assigned
- Dec 8, 2006
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Orthotic Fitter | 225000000X | Yes |
Addresses
Primary practice location
173 Cherry Oak Trail
Petal, MS 39465
Mailing address
173 Cherry Oak Trail
Petal, MS 39465
Phone (601) 543-0268
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0440560 | Medicaid | MS |
Other providers in Petal, MS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.