Provider Demographics
NPI:1316774185
Name:THORNTON, CHRISSIE DANELLE (RDH, OTR)
Entity type:Individual
Prefix:DR
First Name:CHRISSIE
Middle Name:DANELLE
Last Name:THORNTON
Suffix:
Gender:F
Credentials:RDH, OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11614 DAWN ST APT 2
Mailing Address - Street 2:
Mailing Address - City:EAGLE RIVER
Mailing Address - State:AK
Mailing Address - Zip Code:99577-7872
Mailing Address - Country:US
Mailing Address - Phone:907-982-6451
Mailing Address - Fax:
Practice Address - Street 1:4300 B ST STE 104
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99503-5926
Practice Address - Country:US
Practice Address - Phone:907-245-7325
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-17
Last Update Date:2024-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK229717225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist