Provider Demographics
NPI:1063131837
Name:THOMPSON, PAMELA ELAINE (OTR/L)
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:ELAINE
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 1:2550 WINDSOR PL N
Mailing Address - Street 2:
Mailing Address - City:MANDAN
Mailing Address - State:ND
Mailing Address - Zip Code:58554-8151
Mailing Address - Country:US
Mailing Address - Phone:701-638-8106
Mailing Address - Fax:701-450-1486
Practice Address - Street 1:2550 WINDSOR PL N
Practice Address - Street 2:
Practice Address - City:MANDAN
Practice Address - State:ND
Practice Address - Zip Code:58554-8151
Practice Address - Country:US
Practice Address - Phone:701-638-8106
Practice Address - Fax:701-450-1486
Is Sole Proprietor?:No
Enumeration Date:2022-08-25
Last Update Date:2022-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND705225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist