Provider Demographics
NPI:1912533431
Name:THOMPSON, ALEEYAH DENAE (OTR/L)
Entity Type:Individual
Prefix:MS
First Name:ALEEYAH
Middle Name:DENAE
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6725 W 52ND PL APT 1B
Mailing Address - Street 2:
Mailing Address - City:MISSION
Mailing Address - State:KS
Mailing Address - Zip Code:66202-1520
Mailing Address - Country:US
Mailing Address - Phone:314-601-1764
Mailing Address - Fax:
Practice Address - Street 1:6725 W 52ND PL APT 1B
Practice Address - Street 2:
Practice Address - City:MISSION
Practice Address - State:KS
Practice Address - Zip Code:66202-1520
Practice Address - Country:US
Practice Address - Phone:314-601-1764
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-16
Last Update Date:2020-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2018031699225X00000X
KS17-03691225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist