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NPI Code Detail

MEDICARE: DONALD THORSEN

MEDICARE: DONALD THORSEN
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
1225X00000XOccupational Therapist2016017355IL

General Provider Information

NPI Number : 1770930463
Entity Type Code : Individual
Provider Name (Legal Business Name) : DONALD THORSEN
Provider Business Mailing Address
First Line : 600 OAKMONT LN
Second Line : STE 600C
City : WESTMONT
State : IL
Zip : 60559-5548
Country : US
Telephone Number : 630-575-1980
Fax Number : 630-928-5080
Provider Business Practice Location Address
First Line : 951 WATERBURY FALLS DR
Second Line :
City : O FALLON
State : MO
Zip : 63368-2202
Country : US
Telephone Number : 636-336-0297
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/23/2016
Last Update Date : 07/14/2020

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Directions to “ DONALD THORSEN ” Practice Location

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