Healthcare Provider Details

I. General information

NPI: 1184926313
Provider Name (Legal Business Name): RUTH A TREMAINE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/19/2010
Last Update Date: 11/19/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

542 16TH ST
RAWLINS WY
82301-5241
US

IV. Provider business mailing address

PO BOX 1216
GREEN RIVER WY
82935-1216
US

V. Phone/Fax

Practice location:
  • Phone: 307-324-2759
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License NumberCOTA-587
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: