Provider Demographics
NPI:1679759633
Name:THOMPSON, MICHELE RENE (COTA)
Entity Type:Individual
Prefix:MRS
First Name:MICHELE
Middle Name:RENE
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1632 7TH AVE
Mailing Address - Street 2:A
Mailing Address - City:HAMPTON
Mailing Address - State:VA
Mailing Address - Zip Code:23665-1702
Mailing Address - Country:US
Mailing Address - Phone:757-251-7631
Mailing Address - Fax:
Practice Address - Street 1:305 MARCELLA RD
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:VA
Practice Address - Zip Code:23666-2433
Practice Address - Country:US
Practice Address - Phone:757-827-8953
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-21
Last Update Date:2008-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant