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General NPI Number Information
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NPI Number | 1053656090
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Entity Type | Individual
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Provider Name | HEATHER MICHELLE THOMPSON OTR/L
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Gender | Female
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Dates
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Enumeration Date | 12/03/2012
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Last Update Date | 09/18/2020
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Provider Practice Location Address
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Address Line | 200 NW 4TH ST
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City | BRYANT
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State | AR
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Zip | 72022-3424
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Country | US
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Telephone | 501-653-5060
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Fax | 501-653-5931
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Provider Business Mailing Address
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Address Line | 5917 WORTH AVE E
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City | BENTON
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State | AR
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Zip | 72019-6638
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Country | US
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Telephone | 501-209-5553
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 111155
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | OTR2608
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License Number State | AR
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