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General NPI Number Information
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NPI Number | 1508292897
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Entity Type | Individual
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Provider Name | RYAN THURSTON
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Gender | Male
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Dates
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Enumeration Date | 09/19/2013
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Last Update Date | 06/14/2016
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Provider Practice Location Address
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Address Line | 118 BENNETT DR SUITE 140
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City | CARIBOU
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State | ME
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Zip | 04736-2052
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Country | US
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Telephone | 207-498-6334
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Fax | 207-493-3247
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Provider Business Mailing Address
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Address Line | 118 BENNETT DR SUITE 140
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City | CARIBOU
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State | ME
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Zip | 04736-2052
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Country | US
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Telephone | 207-498-6334
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Fax | 207-493-3247
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | OT2568
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License Number State | ME
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