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It's situated about half-way between Phnom Penh and Siem Reap and thus most travellers will only rush through on their transfer between these two major attractions. Nevertheless it is a pleasant and relaxed place and a good starting point for exploring the countryside and the temples of Sambor Prei Kuk.
The same selection of transport should be available from Siem Reap. Mekong Express buses stop at the Arunras Guest house and tickets can be bought from there. Best thing to do is to get the bus to or from Siem Reap to Phnom Pehn, it goes along Route 6 and they can easily stop on the way.
The town is easily explored by foot. There are motorbike-taxis for hire to take you to more distant sights. There is an interesting fruit bat roost in the grounds of the old governors residence a nice colonial era building. This is behind the market on the first road off the river. If the gate to the old governors building is open, you may be in luck, the house itself is sometimes left unlocked.
All of the original furnishings are missing, but some of the bathroom fixtures remain and the house itself gives off a haunted vibe. The grasslands and rice-fields surrounding Kompong Thom of an extreme importance for wildlife conservation. These areas hold the largest global population of the endangered Bustard the Bengal Florican as well as occasional large waterbirds from the Tonle Sap floodplain Adjutants, Pelican, Painted Stork.
Other species include large numbers of wintering palearctic passerines including Dusky Warbler, Yellow-breasted Bunting, Siberian Rubythroat and the globally vulnerable Manchurian Reed Warbler. In March large numbers of Oriental Plover pass through the area making this possibly the best area in the world to see this species.