Provider Demographics
NPI:1699298505
Name:THURSTON, MONICA SUE (COTA)
Entity type:Individual
Prefix:
First Name:MONICA
Middle Name:SUE
Last Name:THURSTON
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4663 HARVEY RD
Mailing Address - Street 2:
Mailing Address - City:CROSBY
Mailing Address - State:TX
Mailing Address - Zip Code:77532-4875
Mailing Address - Country:US
Mailing Address - Phone:806-290-3511
Mailing Address - Fax:
Practice Address - Street 1:4663 HARVEY RD
Practice Address - Street 2:
Practice Address - City:CROSBY
Practice Address - State:TX
Practice Address - Zip Code:77532-4875
Practice Address - Country:US
Practice Address - Phone:806-290-3511
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-23
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX211676224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant