Provider Demographics
NPI:1427879436
Name:THOMPSON, ALLISON MICHELLE (COTA)
Entity type:Individual
Prefix:
First Name:ALLISON
Middle Name:MICHELLE
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15114 BLOYERS AVE
Mailing Address - Street 2:
Mailing Address - City:HAGERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21740-1917
Mailing Address - Country:US
Mailing Address - Phone:301-331-4459
Mailing Address - Fax:
Practice Address - Street 1:13857 APPLE HARVEST DR
Practice Address - Street 2:
Practice Address - City:MARTINSBURG
Practice Address - State:WV
Practice Address - Zip Code:25403-6199
Practice Address - Country:US
Practice Address - Phone:304-596-0996
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-22
Last Update Date:2024-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVC2552224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant