Provider Demographics
NPI:1386251528
Name:THOMPSON, JORDAN (OTD, OTR/L)
Entity type:Individual
Prefix:
First Name:JORDAN
Middle Name:
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:OTD, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1330 N DEARBORN ST APT 1406
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60610-2081
Mailing Address - Country:US
Mailing Address - Phone:641-990-9484
Mailing Address - Fax:
Practice Address - Street 1:220 N 1ST ST
Practice Address - Street 2:
Practice Address - City:WHEELING
Practice Address - State:IL
Practice Address - Zip Code:60090-2980
Practice Address - Country:US
Practice Address - Phone:847-459-8700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-30
Last Update Date:2020-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056.013686225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist