Provider Demographics
NPI:1275721805
Name:THOMPSON, AMBER CATHLEEN (PTA)
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:CATHLEEN
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2503 W DRIFTWOOD DR
Mailing Address - Street 2:
Mailing Address - City:CLAREMORE
Mailing Address - State:OK
Mailing Address - Zip Code:74017-4821
Mailing Address - Country:US
Mailing Address - Phone:918-853-5474
Mailing Address - Fax:
Practice Address - Street 1:2503 W DRIFTWOOD DR
Practice Address - Street 2:
Practice Address - City:CLAREMORE
Practice Address - State:OK
Practice Address - Zip Code:74017-4821
Practice Address - Country:US
Practice Address - Phone:918-853-5474
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-09
Last Update Date:2013-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1584225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant