Healthcare Provider Details

I. General information

NPI: 1285258616
Provider Name (Legal Business Name): KELSI NICOLE THOMPSON OTD, OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/01/2020
Last Update Date: 06/01/2020
Certification Date: 06/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10095 BRICK CHURCH RD
CAMBRIDGE OH
43725-8550
US

IV. Provider business mailing address

112 FOXRIDGE WAY
HEBRON OH
43025-9010
US

V. Phone/Fax

Practice location:
  • Phone: 740-439-8977
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT011062
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: