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NPI Code Detail

MEDICARE: MRS. MARISA MAE THOMPSON MA, OTR/L

MEDICARE: MRS. MARISA MAE THOMPSON MA, 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 Therapist124389TX
2225XP0200XPediatric Occupational Therapist3297CO
3225XP0200XPediatric Occupational Therapist6152MT

General Provider Information

NPI Number : 1780954339
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. MARISA MAE THOMPSON MA, OTR/L
Provider Business Mailing Address
First Line : 9305 SUNSET LN
Second Line :
City : OAK POINT
State : TX
Zip : 75068-2315
Country : US
Telephone Number : 507-202-3227
Fax Number :
Provider Business Practice Location Address
First Line : 3840 HULEN ST STE 100
Second Line :
City : FORT WORTH
State : TX
Zip : 76107-7269
Country : US
Telephone Number : 817-569-4300
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/12/2012
Last Update Date : 04/29/2026

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Directions to “ MRS. MARISA MAE THOMPSON MA, OTR/L” Practice Location

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