Provider Demographics
NPI:1861890402
Name:THOMPSON, MONICA (LMT)
Entity type:Individual
Prefix:
First Name:MONICA
Middle Name:
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 GRANITE ST APT 20
Mailing Address - Street 2:
Mailing Address - City:BIDDEFORD
Mailing Address - State:ME
Mailing Address - Zip Code:04005-3668
Mailing Address - Country:US
Mailing Address - Phone:207-408-1058
Mailing Address - Fax:
Practice Address - Street 1:110 GRANITE ST APT 20
Practice Address - Street 2:
Practice Address - City:BIDDEFORD
Practice Address - State:ME
Practice Address - Zip Code:04005-3668
Practice Address - Country:US
Practice Address - Phone:207-408-1058
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-14
Last Update Date:2014-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMT4732174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist