Provider Demographics
NPI:1437384039
Name:THOMPSON, KATY KATHRYN
Entity Type:Individual
Prefix:MRS
First Name:KATY
Middle Name:KATHRYN
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:KATY
Other - Middle Name:KATHRYN
Other - Last Name:SHRAUNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:4820 S ASH AVENUE
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85282
Mailing Address - Country:US
Mailing Address - Phone:480-345-6578
Mailing Address - Fax:480-345-4081
Practice Address - Street 1:4820 S ASH AVE
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85282-6718
Practice Address - Country:US
Practice Address - Phone:480-345-6578
Practice Address - Fax:480-345-4081
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-27
Last Update Date:2009-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5855174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist