Wylena Nell Thornton, M.A.D.T.
Individual provider Active NPI Developmental Therapist · Burham, IL
NPI 1891703757 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1891703757
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Developmental Therapist 222Q00000X
- Practice address
- 14513 Bensley Ave
Burham, IL 60633-2205 - Phone
- (708) 730-3328
- Fax
- (708) 730-0710
- NPI assigned
- Aug 4, 2006
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Developmental Therapist | 222Q00000X | Yes |
Addresses
Primary practice location
14513 Bensley Ave
Burham, IL 60633-2205
Mailing address
14513 Bensley Ave
Burham, IL 60633-2205
Phone (708) 730-3328
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.