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General NPI Number Information
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NPI Number | 1437836244
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Entity Type | Individual
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Provider Name | MANDI-MAE IRIS THOMPSON L.AC
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Gender | Female
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Dates
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Enumeration Date | 07/03/2023
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Last Update Date | 09/03/2025
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Provider Practice Location Address
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Address Line | 320 EXPRESSWAY STE A
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City | MISSOULA
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State | MT
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Zip | 59808-1571
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Country | US
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Telephone | 402-613-0382
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Fax |
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Provider Business Mailing Address
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Address Line | GENERAL DELIVERY 326 SPRUCE CONE DR
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City | BIG SKY
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State | MT
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Zip | 59716-9999
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Country | US
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Telephone | 402-613-0382
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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 | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | 24563
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License Number State | MT
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Taxonomy #2
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | 117209
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License Number State | MT
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