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General NPI Number Information
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NPI Number | 1902374093
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Entity Type | Individual
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Provider Name | KAROL MAE SANTISTEVAN OTR/L
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Gender | Female
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Dates
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Enumeration Date | 11/06/2018
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Last Update Date | 10/03/2023
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Provider Practice Location Address
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Address Line | 3905 TEN MILE RD
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City | CASPER
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State | WY
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Zip | 82604-2894
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Country | US
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Telephone | 307-267-7416
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Fax | 949-404-6346
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Provider Business Mailing Address
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Address Line | 5825 THIRTY THREE MILE RD
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City | CASPER
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State | WY
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Zip | 82604-9584
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Country | US
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Telephone | 307-267-7416
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Fax | 307-473-7827
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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 | OT-1381
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License Number State | WY
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