Provider Demographics
NPI:1538580675
Name:THOMPSON, GINA ANN (OTR)
Entity type:Individual
Prefix:MRS
First Name:GINA
Middle Name:ANN
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:938 10TH ST N
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:WI
Mailing Address - Zip Code:54016-2384
Mailing Address - Country:US
Mailing Address - Phone:651-786-9772
Mailing Address - Fax:
Practice Address - Street 1:2231 US HIGHWAY 12
Practice Address - Street 2:
Practice Address - City:BALDWIN
Practice Address - State:WI
Practice Address - Zip Code:54002-3269
Practice Address - Country:US
Practice Address - Phone:715-684-5020
Practice Address - Fax:715-688-4444
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-16
Last Update Date:2013-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI284626225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist