Provider Demographics
NPI:1669011102
Name:THOMPSON, MEGHAN MICHAELINE (OTR/L)
Entity Type:Individual
Prefix:
First Name:MEGHAN
Middle Name:MICHAELINE
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:MEGHAN
Other - Middle Name:MICHAELINE
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:185 DELRAY AVE
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14224-1842
Mailing Address - Country:US
Mailing Address - Phone:716-697-5962
Mailing Address - Fax:
Practice Address - Street 1:51 SAINT JOHNS PARKSIDE ST
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14210-2515
Practice Address - Country:US
Practice Address - Phone:716-828-9560
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-02
Last Update Date:2022-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY024346-01225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist