Provider Demographics
NPI:1689880536
Name:THOMISON, AMY JO (LAC)
Entity Type:Individual
Prefix:MS
First Name:AMY
Middle Name:JO
Last Name:THOMISON
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16050 SE UNIONVALE RD
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OR
Mailing Address - Zip Code:97114-8631
Mailing Address - Country:US
Mailing Address - Phone:503-868-7025
Mailing Address - Fax:
Practice Address - Street 1:707 NE 5TH ST
Practice Address - Street 2:
Practice Address - City:MCMINNVILLE
Practice Address - State:OR
Practice Address - Zip Code:97128-4508
Practice Address - Country:US
Practice Address - Phone:503-472-5797
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAC00372171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist