1528236874 NPI number — CENTRAL WYOMING THERAPY, LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528236874 NPI number — CENTRAL WYOMING THERAPY, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CENTRAL WYOMING THERAPY, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1528236874
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/14/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 52190
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CASPER
Provider Business Mailing Address State Name:
WY
Provider Business Mailing Address Postal Code:
82605-2190
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
307-472-3327
Provider Business Mailing Address Fax Number:
307-472-0297

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
300 LANDMARK DR STE B
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CASPER
Provider Business Practice Location Address State Name:
WY
Provider Business Practice Location Address Postal Code:
82609-4233
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
307-472-3327
Provider Business Practice Location Address Fax Number:
307-472-0297
Provider Enumeration Date:
02/20/2008

Additional Information

Authorized Official

Authorized Official Last Name:
KEFFELER
Authorized Official First Name:
CHERYL
Authorized Official Middle Name:
ANNE
Authorized Official Title or Position:
OWNER/OCCUPATIONAL THERAPIST
Authorized Official Telephone Number:
307-472-3327

Provider Taxonomy Codes

  • Taxonomy code: 261QP2000X , with the licence number:  OT476 , registered in the state of WY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 119926900 , issued by the state of ( WY ) . This identifiers is of the category "MEDICAID".




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