Provider Demographics
NPI:1851930143
Name:THURSTON, KYRA JO (OT)
Entity Type:Individual
Prefix:
First Name:KYRA
Middle Name:JO
Last Name:THURSTON
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:PO BOX 388
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45409-0388
Mailing Address - Country:US
Mailing Address - Phone:937-294-2468
Mailing Address - Fax:937-294-2394
Practice Address - Street 1:501 N 17TH AVE
Practice Address - Street 2:
Practice Address - City:BEECH GROVE
Practice Address - State:IN
Practice Address - Zip Code:46107-1169
Practice Address - Country:US
Practice Address - Phone:317-219-3889
Practice Address - Fax:317-324-3965
Is Sole Proprietor?:No
Enumeration Date:2020-01-03
Last Update Date:2020-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN31006912A225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist