Provider Demographics
NPI:1083870885
Name:THOMPSON, SUSAN JOAN (OTR/L)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:JOAN
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2201 LONG PRAIRIE RD
Mailing Address - Street 2:SUITE 107, #810
Mailing Address - City:FLOWER MOUND
Mailing Address - State:TX
Mailing Address - Zip Code:75022-4832
Mailing Address - Country:US
Mailing Address - Phone:972-375-8618
Mailing Address - Fax:302-370-8618
Practice Address - Street 1:2201 LONG PRAIRIE RD
Practice Address - Street 2:SUITE 107, #810
Practice Address - City:FLOWER MOUND
Practice Address - State:TX
Practice Address - Zip Code:75022-4832
Practice Address - Country:US
Practice Address - Phone:972-375-8618
Practice Address - Fax:302-370-8618
Is Sole Proprietor?:No
Enumeration Date:2008-07-31
Last Update Date:2009-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX108722225X00000X
FL13245225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX301Medicaid