Basic Information
Provider Information
NPI: 1083131510
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: THOMPSON
FirstName: DENISE
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: OTR/L
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
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OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 401 LOCUST ST STE 2A
Address2:  
City: CORAOPOLIS
State: PA
PostalCode: 151083954
CountryCode: US
TelephoneNumber: 4122990704
FaxNumber: 4122992823
Practice Location
Address1: 35 N BALPH AVE
Address2:  
City: PITTSBURGH
State: PA
PostalCode: 152023200
CountryCode: US
TelephoneNumber: 4122990704
FaxNumber:  
Other Information
ProviderEnumerationDate: 08/25/2017
LastUpdateDate: 08/25/2017
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
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AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
225X00000XOC004948LPAY Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist 

No ID Information.


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