Basic Information
Provider Information
NPI: 1982913687
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: THOMPSON
FirstName: MERIDITH
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: OTR
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
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OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 7733 FORSYTH BLVD STE 2300
Address2:  
City: SAINT LOUIS
State: MO
PostalCode: 631051806
CountryCode: US
TelephoneNumber: 8006771238
FaxNumber:  
Practice Location
Address1: 7733 FORSYTH BLVD STE 2300
Address2:  
City: SAINT LOUIS
State: MO
PostalCode: 631051806
CountryCode: US
TelephoneNumber: 8006771238
FaxNumber:  
Other Information
ProviderEnumerationDate: 09/28/2010
LastUpdateDate: 09/28/2010
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
225X00000X2007035513MOY Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist 

No ID Information.


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