Active NPI
Kyna Thorberg
- Occupational Therapist
- O'Fallon, MO
National Provider Identifier
1265813505
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- 2004003286
- Practice address
- 203 Country Vista Dr
O Fallon, MO 63367-5856 - Phone
- (636) 357-5617
- NPI assigned
- Jun 12, 2015
- Last updated
- Jun 12, 2015
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Occupational Therapist | 225X00000X | 2004003286 | MO | Primary |
Addresses
Primary practice location
203 Country Vista Dr
O Fallon, MO 63367-5856
Mailing address
203 Country Vista Dr
O Fallon, MO 63367-5856
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2004003286 | MO | MD | Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1434067200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1434067200000",
"number": "1265813505",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "203 COUNTRY VISTA DR",
"city": "O FALLON",
"state": "MO",
"postal_code": "633675856"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "203 COUNTRY VISTA DR",
"city": "O FALLON",
"state": "MO",
"postal_code": "633675856",
"telephone_number": "636-357-5617"
}
],
"practiceLocations": [],
"basic": {
"last_name": "THORBERG",
"first_name": "KYNA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2015-06-12",
"last_updated": "2015-06-12",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "MO",
"license": "2004003286",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in O'Fallon, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 12, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.