Basic Information
| Provider Information | |||||||||
| NPI: | 1568966646 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | THOMPSON | ||||||||
| FirstName: | LISA | ||||||||
| MiddleName: | ANN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4 BLAKE RD | ||||||||
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| City: | SWANZEY | ||||||||
| State: | NH | ||||||||
| PostalCode: | 034465510 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 50 PHEASANT RD | ||||||||
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| City: | PETERBOROUGH | ||||||||
| State: | NH | ||||||||
| PostalCode: | 034582110 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6039247267 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/22/2018 | ||||||||
| LastUpdateDate: | 03/22/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 224Z00000X | 0725 | NH | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapy Assistant |
No ID Information.