MEDICARE: MR. STEVEN W 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	OT 3865	GA

General Provider Information

NPI Number	:	1346410743
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. STEVEN W THOMPSON OTR/L

Provider Business Mailing Address
First Line	:	126 LINCOLN COURT AVE NE
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30329-1813
Country	:	US
Telephone Number	:	770-241-8896
Fax Number	:

Provider Business Practice Location Address
First Line	:	126 LINCOLN COURT AVE NE
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30329-1813
Country	:	US
Telephone Number	:	770-241-8896
Fax Number	:

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

Provider Enumeration Date	:	03/03/2008
Last Update Date	:	03/03/2008

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