Provider Demographics
NPI:1497909527
Name:THOMPSON, TARA LYNN (OTR/L)
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:LYNN
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2738 W NORTH AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60647-9500
Mailing Address - Country:US
Mailing Address - Phone:773-770-6500
Mailing Address - Fax:773-292-9381
Practice Address - Street 1:2738 W NORTH AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60647-9500
Practice Address - Country:US
Practice Address - Phone:773-292-9380
Practice Address - Fax:773-292-9381
Is Sole Proprietor?:No
Enumeration Date:2008-11-17
Last Update Date:2008-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056003670225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist