Healthcare Provider Details

I. General information

NPI: 1568920866
Provider Name (Legal Business Name): EMILY THOMPSON OTR/ L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/05/2019
Last Update Date: 03/05/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

897 N M ST
TULARE CA
93274-2017
US

IV. Provider business mailing address

4846 W CLINTON CT
VISALIA CA
93291-9103
US

V. Phone/Fax

Practice location:
  • Phone: 559-687-1340
  • Fax:
Mailing address:
  • Phone: 608-434-8151
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number19398
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: