Provider Demographics
NPI:1639971401
Name:THORNTON, BRYCEN D (OTR/L)
Entity type:Individual
Prefix:
First Name:BRYCEN
Middle Name:D
Last Name:THORNTON
Suffix:
Gender:
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24621 TRAIL RIDGE PASS
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:MO
Mailing Address - Zip Code:64734-9066
Mailing Address - Country:US
Mailing Address - Phone:620-515-2772
Mailing Address - Fax:
Practice Address - Street 1:5100 INDIAN CREEK PKWY
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66207-4115
Practice Address - Country:US
Practice Address - Phone:913-544-1957
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-25
Last Update Date:2025-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS17-03769225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist