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General NPI Number Information
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NPI Number | 1356603849
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Entity Type | Individual
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Provider Name | LORETTA M THOMPSON OTR
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Gender | Female
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Dates
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Enumeration Date | 06/12/2012
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 5044 175TH AVE
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City | HERSEY
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State | MI
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Zip | 49639-8468
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Country | US
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Telephone | 231-832-2234
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Fax |
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Provider Business Mailing Address
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Address Line | 19270 SENECA AVE
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City | BIG RAPIDS
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State | MI
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Zip | 49307-9508
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Country | US
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Telephone | 231-629-6824
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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 | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 5201004369
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License Number State | MI
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