Provider Demographics
NPI:1487893319
Name:THOMPSON, DEBRA KAY (LOTR)
Entity type:Individual
Prefix:
First Name:DEBRA
Middle Name:KAY
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:LOTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2205 E 70TH ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71105-5321
Mailing Address - Country:US
Mailing Address - Phone:318-795-3388
Mailing Address - Fax:318-795-3399
Practice Address - Street 1:2205 E 70TH ST
Practice Address - Street 2:SUITE 102
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71105-5321
Practice Address - Country:US
Practice Address - Phone:318-795-3388
Practice Address - Fax:318-795-3399
Is Sole Proprietor?:No
Enumeration Date:2009-02-17
Last Update Date:2009-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAOTT.Z12088225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist