Provider Demographics
NPI:1164677084
Name:THURSTON-BROWN, JENNIFER ANN (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:ANN
Last Name:THURSTON-BROWN
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 566
Mailing Address - Street 2:
Mailing Address - City:WESTMORELAND
Mailing Address - State:NY
Mailing Address - Zip Code:13490-0566
Mailing Address - Country:US
Mailing Address - Phone:315-527-3815
Mailing Address - Fax:315-437-4698
Practice Address - Street 1:4791 ROUTE 233
Practice Address - Street 2:
Practice Address - City:WESTMORELAND
Practice Address - State:NY
Practice Address - Zip Code:13490
Practice Address - Country:US
Practice Address - Phone:315-527-3815
Practice Address - Fax:315-437-4698
Is Sole Proprietor?:No
Enumeration Date:2008-11-19
Last Update Date:2008-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011729-1225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics