Basic Information
Provider Information
NPI: 1710999073
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: THOMPSON
FirstName: ROXANNE
MiddleName: HAMRICK
NamePrefix: MRS.
NameSuffix:  
Credential: OTR
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 5648 BROOKHILL LN
Address2:  
City: FRISCO
State: TX
PostalCode: 750344623
CountryCode: US
TelephoneNumber: 9723702734
FaxNumber: 9723702734
Practice Location
Address1: 1201 E 15TH ST
Address2: SUITE 304
City: PLANO
State: TX
PostalCode: 750746238
CountryCode: US
TelephoneNumber: 9724240148
FaxNumber: 9724225275
Other Information
ProviderEnumerationDate: 08/13/2006
LastUpdateDate: 07/09/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
225XP0200X108910TXY Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics

No ID Information.


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