Provider Demographics
NPI:1518681675
Name:THORNTON, KRISTEN
Entity type:Individual
Prefix:
First Name:KRISTEN
Middle Name:
Last Name:THORNTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:206 N MOSBY AVE
Mailing Address - Street 2:
Mailing Address - City:LITTLETON
Mailing Address - State:NC
Mailing Address - Zip Code:27850-7782
Mailing Address - Country:US
Mailing Address - Phone:252-507-0761
Mailing Address - Fax:
Practice Address - Street 1:206 N MOSBY AVE
Practice Address - Street 2:
Practice Address - City:LITTLETON
Practice Address - State:NC
Practice Address - Zip Code:27850-7782
Practice Address - Country:US
Practice Address - Phone:252-319-5900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-03
Last Update Date:2025-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC16405225X00000X
VA0119009734225X00000X
WV2220225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist