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General NPI Number Information
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NPI Number | 1457782823
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Entity Type | Individual
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Provider Name | TAMARA MICHELLE THOMPSON IECE
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Gender | Female
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Dates
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Enumeration Date | 12/10/2013
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Last Update Date | 06/29/2016
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Provider Practice Location Address
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Address Line | 1847 FARNSLEY RD
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City | LOUISVILLE
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State | KY
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Zip | 40216-4701
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Country | US
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Telephone | 502-751-1822
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Fax |
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Provider Business Mailing Address
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Address Line | 1847 FARNSLEY RD
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City | LOUISVILLE
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State | KY
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Zip | 40216-4701
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Country | US
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Telephone | 502-751-1822
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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 | 222Q00000X
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Taxonomy Name | Developmental Therapist
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License Number | 201111882
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License Number State | KY
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