Provider Demographics
NPI:1225751662
Name:THOMPSON, MARISA DEAUN
Entity Type:Individual
Prefix:
First Name:MARISA
Middle Name:DEAUN
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1525 LAKEVILLE DR STE 125
Mailing Address - Street 2:
Mailing Address - City:KINGWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:77339-2069
Mailing Address - Country:US
Mailing Address - Phone:713-208-5509
Mailing Address - Fax:
Practice Address - Street 1:1525 LAKEVILLE DR STE 125
Practice Address - Street 2:
Practice Address - City:KINGWOOD
Practice Address - State:TX
Practice Address - Zip Code:77339-2069
Practice Address - Country:US
Practice Address - Phone:713-208-5509
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-21
Last Update Date:2023-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health