Healthcare Provider Details

I. General information

NPI: 1467781161
Provider Name (Legal Business Name): KARI THOMPSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/09/2009
Last Update Date: 05/16/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

449 S. FITNESS PL
EAGLE ID
83616
US

IV. Provider business mailing address

449 S FITNESS PL
EAGLE ID
83616-6828
US

V. Phone/Fax

Practice location:
  • Phone: 310-344-2276
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number2077
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License NumberOT-897
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: