Provider Demographics
NPI:1730885039
Name:THOMPSON, DORA ANN (OTR/L)
Entity type:Individual
Prefix:MRS
First Name:DORA
Middle Name:ANN
Last Name:THOMPSON
Suffix:
Gender:F
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 1:240 ARDENNES AVE W
Mailing Address - Street 2:
Mailing Address - City:SHAKOPEE
Mailing Address - State:MN
Mailing Address - Zip Code:55379-4645
Mailing Address - Country:US
Mailing Address - Phone:651-307-4111
Mailing Address - Fax:
Practice Address - Street 1:2106 2ND AVE S
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55404-2606
Practice Address - Country:US
Practice Address - Phone:612-874-1603
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-07
Last Update Date:2023-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN103905225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist