Provider Demographics
NPI:1740765965
Name:THOMPSON, LAURA RENEA (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:RENEA
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 1:312 RICHMOND DR
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28540-4081
Mailing Address - Country:US
Mailing Address - Phone:910-581-1895
Mailing Address - Fax:
Practice Address - Street 1:7011 GUM BRANCH RD
Practice Address - Street 2:
Practice Address - City:RICHLANDS
Practice Address - State:NC
Practice Address - Zip Code:28574-8227
Practice Address - Country:US
Practice Address - Phone:910-430-2201
Practice Address - Fax:910-324-4325
Is Sole Proprietor?:No
Enumeration Date:2018-10-03
Last Update Date:2018-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC12107225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist