Provider Demographics
NPI:1689899031
Name:THORNTON, LINDA FAYE (OT)
Entity Type:Individual
Prefix:MRS
First Name:LINDA
Middle Name:FAYE
Last Name:THORNTON
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3338 W TWAIN CT
Mailing Address - Street 2:
Mailing Address - City:ANTHEM
Mailing Address - State:AZ
Mailing Address - Zip Code:85086-1671
Mailing Address - Country:US
Mailing Address - Phone:623-551-9032
Mailing Address - Fax:623-551-9042
Practice Address - Street 1:3200 N DOBSON RD STE F-2
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85224-9611
Practice Address - Country:US
Practice Address - Phone:480-722-1300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-13
Last Update Date:2018-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2770225X00000X
AZOTH-002770225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ611964Medicaid