Individual
JENNIFER MARIE THOMPSON-BOOTHE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MS
Contact information
Practice address
911 S 3RD ST, NILES, MI 49120-3414
(269) 684-4320
Mailing address
19370 STATE LINE RD, SOUTH BEND, IN 46637-2080
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
5201004946
MI
Other
Enumeration date
07/12/2018
Last updated
07/12/2018
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