Healthcare Provider Details

I. General information

NPI: 1295809531
Provider Name (Legal Business Name): CLODAGH THOMPSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/20/2006
Last Update Date: 10/26/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1232 UNIVERSITY OF OREGON
EUGENE OR
97403-1205
US

IV. Provider business mailing address

1232 UNIVERSITY OF OREGON
EUGENE OR
97403-1205
US

V. Phone/Fax

Practice location:
  • Phone: 541-346-4401
  • Fax:
Mailing address:
  • Phone: 541-346-4401
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VII. Legacy identifiers

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

# 1
IdentifierP1233
Identifier TypeOTHER
Identifier StateAK
Identifier IssuerLICENSE#
# 2
Identifier6332
Identifier TypeOTHER
Identifier StateOR
Identifier IssuerOREGON PT LICENSING BOARD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: