Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225X00000X | Occupational Therapist | OT-716 | WY |
Y | 225X00000X | Occupational Therapist | OT716 | WY |
NPI | 1003029653 |
---|---|
Provider Name | Olivia L Donald |
First Address | Casper, WY 82609-2045 |
Second Address | Casper, WY 82609-2045 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/05/2007 |
Last Update Date | 26/07/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
OTR-716 | STATE LICENSE (01) | WY |