Provider Demographics
NPI:1780833624
Name:THOMPSON, MARIANNE JEAN (OTR/L)
Entity Type:Individual
Prefix:
First Name:MARIANNE
Middle Name:JEAN
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 1:3716 E SERENDIPITY LOOP
Mailing Address - Street 2:
Mailing Address - City:WASILLA
Mailing Address - State:AK
Mailing Address - Zip Code:99654-2824
Mailing Address - Country:US
Mailing Address - Phone:907-376-1422
Mailing Address - Fax:907-376-1423
Practice Address - Street 1:3716 E SERENDIPITY LOOP
Practice Address - Street 2:
Practice Address - City:WASILLA
Practice Address - State:AK
Practice Address - Zip Code:99654-2824
Practice Address - Country:US
Practice Address - Phone:907-376-1422
Practice Address - Fax:907-376-1423
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-16
Last Update Date:2008-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK1172225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist