Provider Demographics
NPI:1962714113
Name:THOMPSON, ANNIE ELIZA (COTA/L)
Entity type:Individual
Prefix:
First Name:ANNIE
Middle Name:ELIZA
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:409 BELLEFONTE RD
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:KY
Mailing Address - Zip Code:41102-2311
Mailing Address - Country:US
Mailing Address - Phone:606-923-9424
Mailing Address - Fax:
Practice Address - Street 1:590 POPLAR FORK RD
Practice Address - Street 2:
Practice Address - City:HURRICANE
Practice Address - State:WV
Practice Address - Zip Code:25526-9434
Practice Address - Country:US
Practice Address - Phone:304-757-7826
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-03
Last Update Date:2010-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVC1755224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant