Provider Demographics
NPI:1467690974
Name:THOMPSON, KAREN HERMAN (LMT)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:HERMAN
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 WEST AVE
Mailing Address - Street 2:INSIDE ANGELS AT WORK
Mailing Address - City:SPENCERPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14559-1344
Mailing Address - Country:US
Mailing Address - Phone:585-200-9190
Mailing Address - Fax:
Practice Address - Street 1:24 WEST AVE
Practice Address - Street 2:INSIDE ANGELS AT WORK
Practice Address - City:SPENCERPORT
Practice Address - State:NY
Practice Address - Zip Code:14559-1344
Practice Address - Country:US
Practice Address - Phone:585-200-9190
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-22
Last Update Date:2009-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY19001225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist