Provider Demographics
NPI:1699452458
Name:THOMPSON, ELISABETH RUTH (BSC OT, OTR/L)
Entity type:Individual
Prefix:MISS
First Name:ELISABETH
Middle Name:RUTH
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:BSC OT, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1091 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14209-2305
Mailing Address - Country:US
Mailing Address - Phone:716-242-8200
Mailing Address - Fax:
Practice Address - Street 1:1091 MAIN ST
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14209-2305
Practice Address - Country:US
Practice Address - Phone:716-242-8200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-03
Last Update Date:2023-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY020816-01225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist