Healthcare Provider Details

I. General information

NPI: 1265493902
Provider Name (Legal Business Name): ROCKY MOUNTAIN THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/31/2006
Last Update Date: 05/19/2020
Certification Date: 05/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2546 E 2ND ST BUILDING 500
CASPER WY
82609-2047
US

IV. Provider business mailing address

2546 E 2ND ST BUILDING 500
CASPER WY
82609-2047
US

V. Phone/Fax

Practice location:
  • Phone: 307-577-5204
  • Fax: 307-577-5212
Mailing address:
  • Phone: 307-577-5204
  • Fax: 307-577-5212

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License NumberCOTA-621
License Number StateWY
# 2
Primary TaxonomyN
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License NumberCOTA-534
License Number StateWY
# 3
Primary TaxonomyN
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License NumberCOTA-589
License Number StateWY
# 4
Primary TaxonomyN
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License NumberCOTA-617
License Number StateWY
# 5
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT-891
License Number StateWY
# 6
Primary TaxonomyN
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPTA-331
License Number StateWY
# 7
Primary TaxonomyN
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPTA-537
License Number StateWY
# 8
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOTR-452
License Number StateWY
# 9
Primary TaxonomyN
Taxonomy Code225XH1200X
TaxonomyHand Occupational Therapist
License NumberOTR-031
License Number StateWY
# 10
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSP-169
License Number StateWY
# 11
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSP-395
License Number StateWY

VIII. Authorized Official

Name: MRS. KATHERINE LYNN HOLDER
Title or Position: OWNER
Credential: OTR/L
Phone: 307-577-5204