MEDICARE: SUSAN JOAN THOMPSON OTR/L

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist	108722	TX
2	225X00000X	Occupational Therapist	13245	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1083870885
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSAN JOAN THOMPSON OTR/L

Provider Business Mailing Address
First Line	:	2201 LONG PRAIRIE RD
Second Line	:	SUITE 107, #810
City	:	FLOWER MOUND
State	:	TX
Zip	:	75022-4832
Country	:	US
Telephone Number	:	972-375-8618
Fax Number	:	302-370-8618

Provider Business Practice Location Address
First Line	:	2201 LONG PRAIRIE RD
Second Line	:	SUITE 107, #810
City	:	FLOWER MOUND
State	:	TX
Zip	:	75022-4832
Country	:	US
Telephone Number	:	972-375-8618
Fax Number	:	302-370-8618

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/31/2008
Last Update Date	:	01/01/2009

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