=====================================================
General NPI Number Information
=====================================================
NPI Number | 1821572975
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MICHELLE ANN DOYLE OTR/L
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/24/2018
-----------------------------------------------------
Last Update Date | 09/24/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 502 N ROAD 11
-----------------------------------------------------
City | WORLAND
-----------------------------------------------------
State | WY
-----------------------------------------------------
Zip | 82401-3141
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 307-347-8677
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1500 LANE 16 1/2
-----------------------------------------------------
City | WORLAND
-----------------------------------------------------
State | WY
-----------------------------------------------------
Zip | 82401-8713
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 307-347-6450
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225XP0200X
-----------------------------------------------------
Taxonomy Name | Pediatric Occupational Therapist
-----------------------------------------------------
License Number | OT-086
-----------------------------------------------------
License Number State | WY
-----------------------------------------------------