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General NPI Number Information
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NPI Number | 1417646191
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Entity Type | Individual
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Provider Name | ERNESTINE THOMPSON
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Gender | Female
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Dates
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Enumeration Date | 05/08/2023
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Last Update Date | 05/08/2023
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Provider Practice Location Address
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Address Line | 52 PORTER ST
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City | STOUGHTON
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State | MA
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Zip | 02072
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Country | US
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Telephone | 781-341-3400
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Fax |
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Provider Business Mailing Address
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Address Line | 65 WESTMORE RD
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City | MATTAPAN
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State | MA
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Zip | 02126
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Country | US
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Telephone | 617-256-3355
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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 | 1744P3200X
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Taxonomy Name | Prosthetics Case Management
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License Number | 1103080
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License Number State | MA
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