Provider Demographics
NPI:1528585122
Name:THOMAS, KRISTYN (MOT, OTR/L)
Entity Type:Individual
Prefix:
First Name:KRISTYN
Middle Name:
Last Name:THOMAS
Suffix:
Gender:F
Credentials:MOT, OTR/L
Other - Prefix:
Other - First Name:KRISTYN
Other - Middle Name:
Other - Last Name:KEITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MOT, OTR/L
Mailing Address - Street 1:507 S WEST ST
Mailing Address - Street 2:
Mailing Address - City:GREEN CITY
Mailing Address - State:MO
Mailing Address - Zip Code:63545-1306
Mailing Address - Country:US
Mailing Address - Phone:660-654-1896
Mailing Address - Fax:
Practice Address - Street 1:10 S GREEN ST
Practice Address - Street 2:
Practice Address - City:GREEN CITY
Practice Address - State:MO
Practice Address - Zip Code:63545-1363
Practice Address - Country:US
Practice Address - Phone:660-874-4128
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-24
Last Update Date:2019-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2017028758225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist