Provider Demographics
NPI:1831647908
Name:THOMPSON, TRACY (DS)
Entity Type:Individual
Prefix:MRS
First Name:TRACY
Middle Name:
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:DS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:228 KING ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:NORTHAMPTON
Mailing Address - State:MA
Mailing Address - Zip Code:01060-2364
Mailing Address - Country:US
Mailing Address - Phone:413-727-8552
Mailing Address - Fax:
Practice Address - Street 1:228 KING ST
Practice Address - Street 2:SUITE 2
Practice Address - City:NORTHAMPTON
Practice Address - State:MA
Practice Address - Zip Code:01060-2364
Practice Address - Country:US
Practice Address - Phone:413-727-8552
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-16
Last Update Date:2016-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist