Provider Demographics
NPI:1689709958
Name:WEST, THERSA LYNN (MS OTR L)
Entity Type:Individual
Prefix:
First Name:THERSA
Middle Name:LYNN
Last Name:WEST
Suffix:
Gender:F
Credentials:MS OTR L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:313 N PINE ST
Mailing Address - Street 2:
Mailing Address - City:KIMBALL
Mailing Address - State:SD
Mailing Address - Zip Code:57355-2257
Mailing Address - Country:US
Mailing Address - Phone:605-680-4781
Mailing Address - Fax:
Practice Address - Street 1:300 S BYRON BLVD
Practice Address - Street 2:
Practice Address - City:CHAMBERLAIN
Practice Address - State:SD
Practice Address - Zip Code:57325-9741
Practice Address - Country:US
Practice Address - Phone:605-234-7142
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-23
Last Update Date:2016-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD0729225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ065535Medicaid