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General NPI Number Information
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NPI Number | 1578304986
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Entity Type | Individual
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Provider Name | SOPHIA ANN THOMPSON OTR/L, EP-C
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Gender | Female
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Dates
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Enumeration Date | 06/03/2024
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Last Update Date | 06/03/2024
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Provider Practice Location Address
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Address Line | 14410 METROPOLIS AVE
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City | FORT MYERS
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State | FL
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Zip | 33912-4341
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Country | US
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Telephone | 904-314-7131
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Fax |
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Provider Business Mailing Address
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Address Line | 210 EDGEWATER BRANCH DR
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City | SAINT JOHNS
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State | FL
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Zip | 32259-4420
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Country | US
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Telephone | 904-314-7131
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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 | OT24523
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License Number State | FL
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