Healthcare Provider Details

I. General information

NPI: 1851540470
Provider Name (Legal Business Name): AMANDA LEE DARR OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AMANDA LEE LARSON OTR

II. Dates (important events)

Enumeration Date: 09/18/2008
Last Update Date: 05/23/2022
Certification Date: 05/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

615 HAMILTON ST
DOUGLAS WY
82633-2615
US

IV. Provider business mailing address

615 HAMILTON ST
DOUGLAS WY
82633-2615
US

V. Phone/Fax

Practice location:
  • Phone: 618-730-7358
  • Fax: 307-358-4891
Mailing address:
  • Phone: 307-358-6187
  • Fax: 307-358-4891

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number241683
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: