Provider Demographics
NPI:1538378211
Name:THORNTON, JONATHAN (OTR)
Entity type:Individual
Prefix:
First Name:JONATHAN
Middle Name:
Last Name:THORNTON
Suffix:
Gender:M
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6153 MIRAMONT ST
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80922-3480
Mailing Address - Country:US
Mailing Address - Phone:719-371-3615
Mailing Address - Fax:719-269-8305
Practice Address - Street 1:905 HARDING AVE
Practice Address - Street 2:
Practice Address - City:CANON CITY
Practice Address - State:CO
Practice Address - Zip Code:81212-2147
Practice Address - Country:US
Practice Address - Phone:719-371-3615
Practice Address - Fax:719-269-8305
Is Sole Proprietor?:No
Enumeration Date:2007-05-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist