Healthcare Provider Details

I. General information

NPI: 1639635162
Provider Name (Legal Business Name): HAND THERAPY OF WYOMING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/20/2019
Last Update Date: 02/20/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 BROWNFIELD RD
DOUGLAS WY
82633-2556
US

IV. Provider business mailing address

1211 S DOUGLAS HWY STE 100
GILLETTE WY
82716-4982
US

V. Phone/Fax

Practice location:
  • Phone: 307-670-9191
  • Fax: 307-670-9193
Mailing address:
  • Phone: 307-670-9191
  • Fax: 307-670-9193

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State

VIII. Authorized Official

Name: BRITTANY R SIEFERT
Title or Position: OWNER
Credential: OT
Phone: 307-756-2013