Provider Demographics
NPI:1801968151
Name:THOMPSON, KELLY STARR (MA OTR)
Entity type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:STARR
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:MA OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1306 WESTSHORE DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77094-3315
Mailing Address - Country:US
Mailing Address - Phone:713-582-4423
Mailing Address - Fax:713-758-0387
Practice Address - Street 1:1306 WESTSHORE DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77094-3315
Practice Address - Country:US
Practice Address - Phone:713-582-4423
Practice Address - Fax:713-758-0387
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-14
Last Update Date:2008-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX109632225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX188305001Medicaid