Provider Demographics
NPI:1417052630
Name:THORNTON, NANCY LEE (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:NANCY
Middle Name:LEE
Last Name:THORNTON
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 1:57980 CORTEZ DR
Mailing Address - Street 2:
Mailing Address - City:YUCCA VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92284-6380
Mailing Address - Country:US
Mailing Address - Phone:760-365-2269
Mailing Address - Fax:760-365-2269
Practice Address - Street 1:57980 CORTEZ DR
Practice Address - Street 2:
Practice Address - City:YUCCA VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92284-6380
Practice Address - Country:US
Practice Address - Phone:760-365-2260
Practice Address - Fax:760-365-2269
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOT4618174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOT4618Medicare ID - Type UnspecifiedMEDICARE PROVIDER ID