Individual
LIONEL THOMPSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
COTA
Contact information
Practice address
6101 16TH ST, RACINE, WI 53406-4467
(262) 898-2712
(262) 619-1447
Mailing address
6101 16TH ST, RACINE, WI 53406-4467
(262) 898-2712
(262) 619-1447
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
515527
WI
Other
Enumeration date
05/21/2015
Last updated
05/21/2015
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