MEDICARE: KRISTY HODDER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251C00000X	Developmentally Disabled Services Day Training Agency

General Provider Information

NPI Number	:	1225232507
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTY HODDER

Provider Business Mailing Address
First Line	:	PO BOX 3161
Second Line	:
City	:	ROCK SPRINGS
State	:	WY
Zip	:	82902-3161
Country	:	US
Telephone Number	:	307-371-8771
Fax Number	:

Provider Business Practice Location Address
First Line	:	5020 SPRINGS DR
Second Line	:	APARTMENT 62
City	:	ROCK SPRINGS
State	:	WY
Zip	:	82901-4015
Country	:	US
Telephone Number	:	307-371-8771
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/12/2007
Last Update Date	:	07/08/2007

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