Provider Demographics
NPI:1831725639
Name:THOMPSON, LISA (COTA/L)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:887 PAGE HILL RD
Mailing Address - Street 2:
Mailing Address - City:EAST CORINTH
Mailing Address - State:VT
Mailing Address - Zip Code:05040-9736
Mailing Address - Country:US
Mailing Address - Phone:802-439-3937
Mailing Address - Fax:
Practice Address - Street 1:7 BOOMHOWER RD
Practice Address - Street 2:
Practice Address - City:WOODSVILLE
Practice Address - State:NH
Practice Address - Zip Code:03785-1400
Practice Address - Country:US
Practice Address - Phone:802-249-5577
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-13
Last Update Date:2020-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH0658224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant