Provider Demographics
NPI:1477090819
Name:THOMPSON, MARY KAITLIN (MOT, OTR/L)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:KAITLIN
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:MOT, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22725 22ND DR SE APT A302
Mailing Address - Street 2:
Mailing Address - City:BOTHELL
Mailing Address - State:WA
Mailing Address - Zip Code:98021-7226
Mailing Address - Country:US
Mailing Address - Phone:304-859-4228
Mailing Address - Fax:
Practice Address - Street 1:501 DATE AVE
Practice Address - Street 2:
Practice Address - City:SULTAN
Practice Address - State:WA
Practice Address - Zip Code:98294
Practice Address - Country:US
Practice Address - Phone:360-793-9830
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-24
Last Update Date:2018-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60862259225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA60862259OtherOT LICENSE