MEDICARE: KRISTOPHER WILLIAM 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	224Z00000X	Occupational Therapy Assistant	OTA-050042	AZ

General Provider Information

NPI Number	:	1730936667
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTOPHER WILLIAM THOMPSON

Provider Business Mailing Address
First Line	:	24723 N 115TH AVE
Second Line	:
City	:	SUN CITY
State	:	AZ
Zip	:	85373-9723
Country	:	US
Telephone Number	:	602-625-5112
Fax Number	:

Provider Business Practice Location Address
First Line	:	24723 N 115TH AVE
Second Line	:
City	:	SUN CITY
State	:	AZ
Zip	:	85373-9723
Country	:	US
Telephone Number	:	602-625-5112
Fax Number	:

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

Provider Enumeration Date	:	04/30/2024
Last Update Date	:	04/30/2024

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