Healthcare Provider Details

I. General information

NPI: 1669302048
Provider Name (Legal Business Name): MEADOWLARK OCUPATIONAL THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/19/2026
Last Update Date: 05/19/2026
Certification Date: 05/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 W LAKEWAY RD STE E
GILLETTE WY
82718-5774
US

IV. Provider business mailing address

PO BOX 313
GILLETTE WY
82717-0313
US

V. Phone/Fax

Practice location:
  • Phone: 406-200-1887
  • Fax:
Mailing address:
  • Phone: 307-689-8567
  • Fax: 406-258-0576

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: ASHLEY ELIZABETH ROGERS
Title or Position: OWNER / PROVIDER
Credential: OTD
Phone: 307-689-8567