Provider Demographics
NPI:1275195935
Name:THOMSON, CAROLYN 'CAZ' MARY
Entity Type:Individual
Prefix:MRS
First Name:CAROLYN 'CAZ'
Middle Name:MARY
Last Name:THOMSON
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 1:22546 SW RICKARD PL
Mailing Address - Street 2:
Mailing Address - City:SHERWOOD
Mailing Address - State:OR
Mailing Address - Zip Code:97140-8221
Mailing Address - Country:US
Mailing Address - Phone:503-330-6072
Mailing Address - Fax:
Practice Address - Street 1:22546 SW RICKARD PL
Practice Address - Street 2:
Practice Address - City:SHERWOOD
Practice Address - State:OR
Practice Address - Zip Code:97140-8221
Practice Address - Country:US
Practice Address - Phone:503-330-6072
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-02
Last Update Date:2021-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer