Provider Demographics
NPI:1861844896
Name:THOMPSON, ELIZABETH ANN I (OCCUPATIONAL THERAPI)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:ANN
Last Name:THOMPSON
Suffix:I
Gender:F
Credentials:OCCUPATIONAL THERAPI
Other - Prefix:
Other - First Name:BETH
Other - Middle Name:A
Other - Last Name:THOMPSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OT
Mailing Address - Street 1:302 CORBIN DR
Mailing Address - Street 2:
Mailing Address - City:BARNEVELD
Mailing Address - State:WI
Mailing Address - Zip Code:53507-9431
Mailing Address - Country:US
Mailing Address - Phone:616-307-5907
Mailing Address - Fax:
Practice Address - Street 1:808 S WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:CUBA CITY
Practice Address - State:WI
Practice Address - Zip Code:53807-1439
Practice Address - Country:US
Practice Address - Phone:608-744-2963
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-01
Last Update Date:2016-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4890-26225XP0019X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0019XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPhysical Rehabilitation