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General NPI Number Information
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NPI Number | 1225465669
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Entity Type | Organization
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Legal Business Name | ELITE THERAPY SERVICES
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Dates
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Enumeration Date | 09/30/2013
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Last Update Date | 12/29/2022
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Provider Practice Location Address
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Address Line | 333 S BEECH ST
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City | CASPER
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State | WY
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Zip | 82601-2805
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Country | US
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Telephone | 307-258-4546
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Fax | 307-337-1279
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Provider Business Mailing Address
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Address Line | PO BOX 382
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City | CASPER
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State | WY
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Zip | 82602-0382
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Country | US
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Telephone | 307-277-1283
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Fax | 307-337-1279
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Authorized Official
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Title or Position | OWNER
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Name | JAMIE NICOLE SOLDAT
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Credential | COTA/L
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Telephone | 307-277-1283
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | OTR-827
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License Number State | WY
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Taxonomy #2
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number |
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License Number State |
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