Healthcare Provider Details

I. General information

NPI: 1578082871
Provider Name (Legal Business Name): ALISON THOMPSON PROFESSIONAL LIMITED-LIABILITY COMPANY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/18/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2305 W HORIZON RIDGE PKWY APT 1922
HENDERSON NV
89052-5792
US

IV. Provider business mailing address

2305 W HORIZON RIDGE PKWY APT 1922
HENDERSON NV
89052-5792
US

V. Phone/Fax

Practice location:
  • Phone: 414-416-9343
  • Fax:
Mailing address:
  • Phone: 414-416-9343
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number14-0473
License Number StateNV

VIII. Authorized Official

Name: ALISON THOMPSON
Title or Position: OWNER/OCCUPATIONAL THERAPIST
Credential:
Phone: 414-416-9343