Provider Demographics
NPI:1649426701
Name:THOMPSON, HOLLY M (LAC)
Entity type:Individual
Prefix:
First Name:HOLLY
Middle Name:M
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:LAC
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 169
Mailing Address - Street 2:
Mailing Address - City:LAKE ELMORE
Mailing Address - State:VT
Mailing Address - Zip Code:05657-0169
Mailing Address - Country:US
Mailing Address - Phone:802-253-8900
Mailing Address - Fax:
Practice Address - Street 1:996 S MAIN ST
Practice Address - Street 2:
Practice Address - City:STOWE
Practice Address - State:VT
Practice Address - Zip Code:05672-5195
Practice Address - Country:US
Practice Address - Phone:802-253-8900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-08
Last Update Date:2008-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT091-0000125171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist