Healthcare Provider Details

I. General information

NPI: 1700190063
Provider Name (Legal Business Name): JAN ALAIR THOMPSON LCPO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/28/2010
Last Update Date: 05/13/2022
Certification Date: 05/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7942 NOBLE VIEW LN NW
OLYMPIA WA
98502-9629
US

IV. Provider business mailing address

7942 NOBLE VIEW LN NW
OLYMPIA WA
98502-9629
US

V. Phone/Fax

Practice location:
  • Phone: 360-628-8265
  • Fax: 888-570-2341
Mailing address:
  • Phone: 360-791-2207
  • Fax: 888-570-2341

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code224P00000X
TaxonomyProsthetist
License NumberPS00000056
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code222Z00000X
TaxonomyOrthotist
License NumberOI00000055
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: