=====================================================
General NPI Number Information
=====================================================
NPI Number | 1669294476
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | VIOLA I TAYLOR COTA/L 786
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/31/2024
-----------------------------------------------------
Last Update Date | 10/31/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 120 S 17TH ST
-----------------------------------------------------
City | WORLAND
-----------------------------------------------------
State | WY
-----------------------------------------------------
Zip | 82401-3637
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 307-347-4001
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1102 S 6TH ST
-----------------------------------------------------
City | BASIN
-----------------------------------------------------
State | WY
-----------------------------------------------------
Zip | 82410-9545
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 307-462-1998
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 224Z00000X
-----------------------------------------------------
Taxonomy Name | Occupational Therapy Assistant
-----------------------------------------------------
License Number | 786
-----------------------------------------------------
License Number State | WY
-----------------------------------------------------