Healthcare Provider Details

I. General information

NPI: 1417201161
Provider Name (Legal Business Name): JESSICA MCMAHAN OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/02/2012
Last Update Date: 03/30/2026
Certification Date: 03/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

606 S DAVID ST
CASPER WY
82601-3136
US

IV. Provider business mailing address

606 S DAVID ST
CASPER WY
82601-3136
US

V. Phone/Fax

Practice location:
  • Phone: 307-333-1251
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: