Provider Demographics
NPI:1447796131
Name:THOMPSON, MARGARET ELENA (LAT, ATC)
Entity Type:Individual
Prefix:MRS
First Name:MARGARET
Middle Name:ELENA
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:409 BAYBERRY CREEK CIR
Mailing Address - Street 2:
Mailing Address - City:MOORESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28117-6645
Mailing Address - Country:US
Mailing Address - Phone:704-662-9852
Mailing Address - Fax:
Practice Address - Street 1:107 KILSON DR STE 107
Practice Address - Street 2:
Practice Address - City:MOORESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28117-8182
Practice Address - Country:US
Practice Address - Phone:704-323-2629
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-18
Last Update Date:2017-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2011174400000X, 405300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes405300000XOther Service ProvidersPrevention Professional
No174400000XOther Service ProvidersSpecialist