Provider Demographics
NPI:1649232570
Name:THRUSTON, KIMBERLY SONKIN (MOT OTRL CHT)
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:SONKIN
Last Name:THRUSTON
Suffix:
Gender:F
Credentials:MOT OTRL CHT
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:
Other - Last Name:SONKIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1583
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22902-1583
Mailing Address - Country:US
Mailing Address - Phone:434-982-7794
Mailing Address - Fax:434-982-7752
Practice Address - Street 1:410 ALBEMARLE SQ
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22901-7400
Practice Address - Country:US
Practice Address - Phone:434-817-4278
Practice Address - Fax:434-817-4279
Is Sole Proprietor?:No
Enumeration Date:2006-04-05
Last Update Date:2008-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0119002963225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010349087Medicaid
VAP00377986OtherMEDICARE PIN
VAP00377986OtherMEDICARE PIN
VA5892500001Medicare NSC