Provider Demographics
NPI:1356603849
Name:THOMPSON, LORETTA M (OTR)
Entity type:Individual
Prefix:
First Name:LORETTA
Middle Name:M
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19270 SENECA AVE
Mailing Address - Street 2:
Mailing Address - City:BIG RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49307-9508
Mailing Address - Country:US
Mailing Address - Phone:231-629-6824
Mailing Address - Fax:
Practice Address - Street 1:5044 175TH AVE
Practice Address - Street 2:
Practice Address - City:HERSEY
Practice Address - State:MI
Practice Address - Zip Code:49639-8468
Practice Address - Country:US
Practice Address - Phone:231-832-2234
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-12
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5201004369225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist