Provider Demographics
NPI:1225887995
Name:THOMPSON, KATHRINE LOUELLA
Entity type:Individual
Prefix:
First Name:KATHRINE
Middle Name:LOUELLA
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1420 CULLEN AVE
Mailing Address - Street 2:
Mailing Address - City:BUCYRUS
Mailing Address - State:OH
Mailing Address - Zip Code:44820-3305
Mailing Address - Country:US
Mailing Address - Phone:419-835-6088
Mailing Address - Fax:
Practice Address - Street 1:156 WILLIAMS ST
Practice Address - Street 2:
Practice Address - City:BUCYRUS
Practice Address - State:OH
Practice Address - Zip Code:44820-3405
Practice Address - Country:US
Practice Address - Phone:419-569-4484
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-15
Last Update Date:2024-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide