Healthcare Provider Details

I. General information

NPI: 1104732965
Provider Name (Legal Business Name): GARRETT COATS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/21/2026
Last Update Date: 08/21/2026
Certification Date: 08/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2112 THORNDIKE AVE
CASPER WY
82601-5030
US

IV. Provider business mailing address

2112 THORNDIKE AVE
CASPER WY
82601-5030
US

V. Phone/Fax

Practice location:
  • Phone: 541-530-2856
  • Fax:
Mailing address:
  • Phone: 541-530-2856
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number237824800
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: