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NPI Code Detail

MEDICARE: DEANNA VAILLANCOURT-THOMPSON OTR/L

MEDICARE: DEANNA VAILLANCOURT-THOMPSON OTR/L
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225X00000XOccupational Therapist11557CA

General Provider Information

NPI Number : 1184154353
Entity Type Code : Individual
Provider Name (Legal Business Name) : DEANNA VAILLANCOURT-THOMPSON OTR/L
Provider Business Mailing Address
First Line : 1060 ELEANOR AVE
Second Line :
City : ROHNERT PARK
State : CA
Zip : 94928-1833
Country : US
Telephone Number : 707-843-7770
Fax Number :
Provider Business Practice Location Address
First Line : 300 DOUGLAS ST
Second Line :
City : PETALUMA
State : CA
Zip : 94952-2503
Country : US
Telephone Number : 707-763-6887
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/19/2017
Last Update Date : 06/19/2017

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Directions to “ DEANNA VAILLANCOURT-THOMPSON OTR/L” Practice Location

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