Provider Demographics
NPI:1740657808
Name:THOMPSON, MICHELLE MARIE (COTA/L)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:MARIE
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:MARIE
Other - Last Name:MCGENITY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:COTA/L
Mailing Address - Street 1:1729 2ND ST
Mailing Address - Street 2:
Mailing Address - City:RADFORD
Mailing Address - State:VA
Mailing Address - Zip Code:24141-1218
Mailing Address - Country:US
Mailing Address - Phone:540-761-6108
Mailing Address - Fax:
Practice Address - Street 1:1729 2ND ST
Practice Address - Street 2:
Practice Address - City:RADFORD
Practice Address - State:VA
Practice Address - Zip Code:24141-1218
Practice Address - Country:US
Practice Address - Phone:540-761-6108
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-25
Last Update Date:2023-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0131000464224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0131000464OtherVIRGINIA BOARD OF PROFESSIONAL SERVICES