Healthcare Provider Details

I. General information

NPI: 1366600041
Provider Name (Legal Business Name): ADRIENNE M HARVEY OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/29/2008
Last Update Date: 11/23/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

639 W COULTER AVE
POWELL WY
82435-2527
US

IV. Provider business mailing address

720 LINDSAY LN
CODY WY
82414-4103
US

V. Phone/Fax

Practice location:
  • Phone: 307-754-9262
  • Fax: 307-754-9283
Mailing address:
  • Phone: 307-578-1970
  • Fax: 307-578-1973

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOTR-549
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: