MEDICARE: MICHELLE LYNN THOMPSON M.S., 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
1	225X00000X	Occupational Therapist	0119000339	VA

General Provider Information

NPI Number	:	1588038624
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHELLE LYNN THOMPSON M.S., OTR/L

Provider Business Mailing Address
First Line	:	9401 FERNLEIGH DR
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23235-1311
Country	:	US
Telephone Number	:	804-221-5041
Fax Number	:

Provider Business Practice Location Address
First Line	:	9401 FERNLEIGH DR
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23235-1311
Country	:	US
Telephone Number	:	804-221-5041
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/29/2015
Last Update Date	:	11/29/2015

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