Individual
NICOLE MARIE THOMPSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OTR/L
Contact information
Practice address
3415 SHERIDAN RD, KENOSHA, WI 53140-1924
(262) 657-6175
Mailing address
2408 N 68TH ST, WAUWATOSA, WI 53213-1306
(414) 416-3783
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
640226
WI
Other
Enumeration date
12/04/2018
Last updated
12/04/2018
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