Provider Demographics
NPI:1104641430
Name:THOMPSON, MADELYNN CAMILLE
Entity type:Individual
Prefix:
First Name:MADELYNN
Middle Name:CAMILLE
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MADELYNN
Other - Middle Name:CAMILLE
Other - Last Name:LEHMANN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:12115 S BLACKBOB RD APT 308
Mailing Address - Street 2:
Mailing Address - City:OLATHE
Mailing Address - State:KS
Mailing Address - Zip Code:66062-6907
Mailing Address - Country:US
Mailing Address - Phone:817-681-0457
Mailing Address - Fax:
Practice Address - Street 1:6223 SLATER ST
Practice Address - Street 2:
Practice Address - City:MERRIAM
Practice Address - State:KS
Practice Address - Zip Code:66202-2848
Practice Address - Country:US
Practice Address - Phone:816-845-9100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-21
Last Update Date:2024-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1801957224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant