Healthcare Provider Details

I. General information

NPI: 1144146655
Provider Name (Legal Business Name): GRACE MCCONNELL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2026
Last Update Date: 06/29/2026
Certification Date: 06/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1215 E FOX FARM RD
CHEYENNE WY
82007-2556
US

IV. Provider business mailing address

PO BOX 20909
CHEYENNE WY
82003-7019
US

V. Phone/Fax

Practice location:
  • Phone: 970-420-2839
  • Fax: 970-226-8520
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: