Provider Demographics
NPI:1417231812
Name:THOMPSON, KIMBERLY ERIN (MT-BC)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:ERIN
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:MT-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12304 NW BARNES RD
Mailing Address - Street 2:APT 571
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97229-5944
Mailing Address - Country:US
Mailing Address - Phone:315-491-3117
Mailing Address - Fax:
Practice Address - Street 1:12304 NW BARNES RD
Practice Address - Street 2:APT 571
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97229-5944
Practice Address - Country:US
Practice Address - Phone:315-491-3117
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-04
Last Update Date:2011-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist