Healthcare Provider Details

I. General information

NPI: 1982324562
Provider Name (Legal Business Name): KALEB MICHAEL THOMPSON
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/01/2022
Last Update Date: 09/01/2022
Certification Date: 08/31/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2360 E MOUND STREET
BEXLEY OH
43209-2424
US

IV. Provider business mailing address

2045 CASE RD
COLUMBUS OH
43224-2406
US

V. Phone/Fax

Practice location:
  • Phone: 614-236-6209
  • Fax:
Mailing address:
  • Phone: 614-373-2276
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: