MEDICARE: MS. KATHLEEN MARIE THOMPSON

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	225700000X	Massage Therapist

General Provider Information

NPI Number	:	1093050536
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KATHLEEN MARIE THOMPSON

Provider Business Mailing Address
First Line	:	5826 N SHELDON RD
Second Line	:
City	:	CANTON
State	:	MI
Zip	:	48187-3153
Country	:	US
Telephone Number	:	734-419-9975
Fax Number	:

Provider Business Practice Location Address
First Line	:	5826 N SHELDON RD
Second Line	:
City	:	CANTON
State	:	MI
Zip	:	48187-3153
Country	:	US
Telephone Number	:	734-419-9975
Fax Number	:

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

Provider Enumeration Date	:	12/11/2012
Last Update Date	:	12/11/2012

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