Provider Demographics
NPI:1386259927
Name:THOMPSON, TAMRA MARJORIE (LMT)
Entity type:Individual
Prefix:
First Name:TAMRA
Middle Name:MARJORIE
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:TAMRA
Other - Middle Name:M
Other - Last Name:THOMPSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:TAMRA SAYERS
Mailing Address - Street 1:7124 COMMONS DR UNIT D
Mailing Address - Street 2:
Mailing Address - City:CHEYENNE
Mailing Address - State:WY
Mailing Address - Zip Code:82009-2620
Mailing Address - Country:US
Mailing Address - Phone:307-635-6777
Mailing Address - Fax:
Practice Address - Street 1:7124 COMMONS DR UNIT D
Practice Address - Street 2:
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82009-2620
Practice Address - Country:US
Practice Address - Phone:307-635-6777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-10
Last Update Date:2020-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYOL-21-41284225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WYOL-21-35997OtherCITY LICENSE