Provider Demographics
NPI:1144828005
Name:THOMPSON, CIELO
Entity type:Individual
Prefix:
First Name:CIELO
Middle Name:
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1016 SW 44TH ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73109-3616
Mailing Address - Country:US
Mailing Address - Phone:405-221-8595
Mailing Address - Fax:
Practice Address - Street 1:1016 SW 44TH ST STE 400
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73109-3617
Practice Address - Country:US
Practice Address - Phone:405-221-8595
Practice Address - Fax:405-931-0022
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-13
Last Update Date:2023-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2383224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant