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General NPI Number Information
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NPI Number | 1568953859
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Entity Type | Individual
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Provider Name | DIANE BALLARD THOMSON MS, OTR/L, ATP
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Gender | Female
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Dates
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Enumeration Date | 05/23/2018
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Last Update Date | 05/23/2018
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Provider Practice Location Address
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Address Line | 261 MACK AVE
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City | DETROIT
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State | MI
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Zip | 48201-2417
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Country | US
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Telephone | 313-745-1004
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Fax | 313-745-9064
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Provider Business Mailing Address
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Address Line | 4250 PEARL CT
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City | DEXTER
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State | MI
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Zip | 48130-9489
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Country | US
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Telephone | 734-604-1498
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Fax | 313-745-9064
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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 | 5201003167
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License Number State | MI
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