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General NPI Number Information
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NPI Number | 1487836649
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Entity Type | Individual
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Provider Name | GENAE ELISE HERBIG M.S.O.T.R./L.
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Gender | Female
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Dates
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Enumeration Date | 11/29/2007
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Last Update Date | 10/17/2011
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Provider Practice Location Address
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Address Line | 107 N WASHINGTON ST
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City | CASPER
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State | WY
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Zip | 82601-2736
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Country | US
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Telephone | 307-315-6184
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Fax | 307-315-6185
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Provider Business Mailing Address
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Address Line | PO BOX 1569
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City | CASPER
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State | WY
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Zip | 82602-1569
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Country | US
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Telephone | 307-315-6184
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Fax | 307-315-6185
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 683
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License Number State | WY
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