Provider Demographics
NPI:1265092787
Name:THOMPSON, DANIELLE A
Entity type:Individual
Prefix:MRS
First Name:DANIELLE
Middle Name:A
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 50218
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85076-0218
Mailing Address - Country:US
Mailing Address - Phone:480-398-4280
Mailing Address - Fax:480-398-4281
Practice Address - Street 1:854 E WILLIAMS FIELD RD STE 105
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85295-0703
Practice Address - Country:US
Practice Address - Phone:480-398-4280
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-17
Last Update Date:2019-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZOTA-000064224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant