MEDICARE: JONATHAN THORNTON OTR

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist

General Provider Information

NPI Number	:	1538378211
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JONATHAN THORNTON OTR

Provider Business Mailing Address
First Line	:	6153 MIRAMONT ST
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80922-3480
Country	:	US
Telephone Number	:	719-371-3615
Fax Number	:	719-269-8305

Provider Business Practice Location Address
First Line	:	905 HARDING AVE
Second Line	:
City	:	CANON CITY
State	:	CO
Zip	:	81212-2147
Country	:	US
Telephone Number	:	719-371-3615
Fax Number	:	719-269-8305

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/21/2007
Last Update Date	:	07/08/2007

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Directions to “ JONATHAN THORNTON OTR” Practice Location

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