1609125103 NPI number — MRS. LIESL THOMPSON JONES O.T.

Table of content: MRS. LIESL THOMPSON JONES O.T. (NPI 1609125103)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609125103 NPI number — MRS. LIESL THOMPSON JONES O.T.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JONES
Provider First Name:
LIESL
Provider Middle Name:
THOMPSON
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
O.T.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
THOMPSON
Provider Other First Name:
LIESL
Provider Other Middle Name:
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
O.T.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1609125103
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/30/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
515 WEST MAIN STREET
Provider Second Line Business Mailing Address:
SUITE 111
Provider Business Mailing Address City Name:
ALLEN
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75013
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
214-509-6961
Provider Business Mailing Address Fax Number:
214-382-0943

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
515 WEST MAIN STREET
Provider Second Line Business Practice Location Address:
SUITE 111
Provider Business Practice Location Address City Name:
ALLEN
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75013
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
214-509-6961
Provider Business Practice Location Address Fax Number:
214-382-0943
Provider Enumeration Date:
08/30/2012

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225XP0200X , with the licence number:  109178 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com