Provider Demographics
NPI:1952606758
Name:THOMPSON, JAMIE LYNN (LMT)
Entity Type:Individual
Prefix:MS
First Name:JAMIE
Middle Name:LYNN
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 HENSHAW ST
Mailing Address - Street 2:SUITE BB
Mailing Address - City:BRIGHTON
Mailing Address - State:MA
Mailing Address - Zip Code:02135-2905
Mailing Address - Country:US
Mailing Address - Phone:617-903-7363
Mailing Address - Fax:
Practice Address - Street 1:17 HENSHAW ST
Practice Address - Street 2:SUITE BB
Practice Address - City:BRIGHTON
Practice Address - State:MA
Practice Address - Zip Code:02135-2905
Practice Address - Country:US
Practice Address - Phone:617-903-7363
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-26
Last Update Date:2011-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAMT-9356-MT225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist