Individual
NICOLE KRISTINE THOMPSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DT, OTD, CBIS
Contact information
Practice address
11109 PARKVIEW PLAZA DR, FORT WAYNE, IN 46845-1701
(260) 266-4010
Mailing address
2626 SAINT JOE CENTER RD, FORT WAYNE, IN 46825-5042
(260) 497-0328
Taxonomy
Speciality
Code
Description
License number
State
222Q00000X
Developmental Therapist
Primary
—
—
225X00000X
Occupational Therapist
31007764A
IN
Other
Enumeration date
05/24/2019
Last updated
05/08/2023
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