Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist |
NPI | 1003578220 |
---|---|
Provider Name | Michalyn Trimble |
First Address | Newcastle, WY 82701-3037 |
Second Address | Newcastle, WY 82701-3037 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/10/2021 |
Last Update Date | 06/10/2021 |