Provider Demographics
NPI:1831783968
Name:THOMPSON, TYE CALLAN (CTRS/L)
Entity type:Individual
Prefix:
First Name:TYE
Middle Name:CALLAN
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:CTRS/L
Other - Prefix:
Other - First Name:CATHERINE
Other - Middle Name:VIRGINIA
Other - Last Name:THOMPSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CTRS/L
Mailing Address - Street 1:121 TECHNOLOGY DR STE 161
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NH
Mailing Address - Zip Code:03824-4723
Mailing Address - Country:US
Mailing Address - Phone:603-862-6174
Mailing Address - Fax:603-862-0249
Practice Address - Street 1:121 TECHNOLOGY DR STE 161
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NH
Practice Address - Zip Code:03824-4723
Practice Address - Country:US
Practice Address - Phone:603-862-6174
Practice Address - Fax:603-862-0249
Is Sole Proprietor?:No
Enumeration Date:2021-03-01
Last Update Date:2021-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH0031225800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRecreation Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH0031OtherNH RT LICENSE