Provider Demographics
NPI:1437482957
Name:THOMPSON, BRENT (OTR/L)
Entity type:Individual
Prefix:
First Name:BRENT
Middle Name:
Last Name:THOMPSON
Suffix:
Gender:M
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2601 SOMERSET DR
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70131-5227
Mailing Address - Country:US
Mailing Address - Phone:504-628-4765
Mailing Address - Fax:504-265-0788
Practice Address - Street 1:2601 SOMERSET DR
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70131-5227
Practice Address - Country:US
Practice Address - Phone:504-628-4765
Practice Address - Fax:504-265-0788
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-15
Last Update Date:2015-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY019746-1225X00000X
LAOTT.Z11853225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist