Healthcare Provider Details

I. General information

NPI: 1689340465
Provider Name (Legal Business Name): ALYSSA MICHELE THOMPSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2021
Last Update Date: 08/20/2021
Certification Date: 08/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 CONOWINGO RD
BEL AIR MD
21014-1843
US

IV. Provider business mailing address

2100 CONOWINGO RD
BEL AIR MD
21014-1843
US

V. Phone/Fax

Practice location:
  • Phone: 410-638-4170
  • Fax:
Mailing address:
  • Phone: 410-638-4170
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: