| Doctor Name: | THOMAS WESLEY |
| NPI Number: | 1467826479 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | |
| License Number: | 33 |
| Business Practice Address: | S82w22885 Parkwood Trl Big Bend, WI - 531039453 |
| Business Phone Number: | 4147500123 |
| Business Fax Number: | |
| Mailing Address: | S82w22885 Parkwood Trl, BIG BEND |
| State: | WI |
| Postal Code: | 531039453 |
| Phone Number: | 4147500123 |
| Fax Number: | |
| NPI Enumeration Date: | 11/15/2015 |
| NPI Last Update Date: | 11/15/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 332BC3200X |
| License Number: | 33 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | WI |
| Taxonomy Type: | Suppliers |
| Taxonomy Classification: | Durable Medical Equipment & Medical Supplies |
| Taxonomy Specialization: | Customized Equipment |
| Taxonomy Definition: | |