Healthcare Provider Details

I. General information

NPI: 1780954339
Provider Name (Legal Business Name): MARISA MAE THOMPSON MA, OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARISA MAE GRUNKLEE

II. Dates (important events)

Enumeration Date: 01/12/2012
Last Update Date: 04/16/2026
Certification Date: 04/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9305 SUNSET LN
OAK POINT TX
75068-2315
US

IV. Provider business mailing address

9305 SUNSET LN
OAK POINT TX
75068-2315
US

V. Phone/Fax

Practice location:
  • Phone: 507-202-3227
  • Fax:
Mailing address:
  • Phone: 507-202-3227
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number3297
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number6152
License Number StateMT
# 3
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number124389
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: