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General NPI Number Information
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NPI Number | 1821933417
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Entity Type | Individual
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Provider Name | TARA THOMPSON
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Gender | Female
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Dates
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Enumeration Date | 04/21/2026
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Last Update Date | 04/21/2026
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Provider Practice Location Address
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Address Line | 7362 E POINT DOUGLAS RD S
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City | COTTAGE GROVE
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State | MN
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Zip | 55016-3025
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Country | US
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Telephone | 651-246-1249
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Fax |
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Provider Business Mailing Address
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Address Line | 1311 CLEVELAND AVE N
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City | SAINT PAUL
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State | MN
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Zip | 55108-1828
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Country | US
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Telephone |
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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 | 224ZE0001X
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Taxonomy Name | Environmental Modification Occupational Therapy Assistant
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License Number | 202600
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License Number State | MN
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