Provider Demographics
NPI:1386462307
Name:THORNTON, CHARLES LEE (OTRL)
Entity type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:LEE
Last Name:THORNTON
Suffix:
Gender:M
Credentials:OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3809 HARROGATE DR
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73072-4246
Mailing Address - Country:US
Mailing Address - Phone:405-202-3825
Mailing Address - Fax:
Practice Address - Street 1:3809 HARROGATE DR
Practice Address - Street 2:
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73072-4246
Practice Address - Country:US
Practice Address - Phone:405-202-3825
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-30
Last Update Date:2024-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1239225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist