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General NPI Number Information
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NPI Number | 1306117445
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Entity Type | Individual
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Provider Name | MRS. LAURA LEE THOMPSON
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Gender | Female
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Dates
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Enumeration Date | 01/20/2012
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Last Update Date | 01/20/2012
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Provider Practice Location Address
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Address Line | 4554 W 48TH ST
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City | FREMONT
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State | MI
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Zip | 49412-8721
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Country | US
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Telephone | 231-924-9295
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Fax |
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Provider Business Mailing Address
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Address Line | 6151 104TH ST
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City | HOWARD CITY
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State | MI
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Zip | 49329-9611
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Country | US
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Telephone | 231-937-5722
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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 | 224Z00000X
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Taxonomy Name | Occupational Therapy Assistant
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License Number | 5202007038
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License Number State | MI
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