Provider Demographics
NPI:1932323177
Name:THOMPSON - CATO, NICHOLE (OTR)
Entity type:Individual
Prefix:MRS
First Name:NICHOLE
Middle Name:
Last Name:THOMPSON - CATO
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 1:9231 S CREGIER AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60617-3602
Mailing Address - Country:US
Mailing Address - Phone:773-343-0258
Mailing Address - Fax:773-734-7802
Practice Address - Street 1:9231 S CREGIER AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60617-3602
Practice Address - Country:US
Practice Address - Phone:773-343-0258
Practice Address - Fax:773-734-7802
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN31002624A225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist