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General NPI Number Information
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NPI Number | 1902380934
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Entity Type | Individual
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Provider Name | KELSEY ANNE HIEB MOTR/L
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Gender | Female
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Dates
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Enumeration Date | 09/15/2018
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Last Update Date | 09/15/2018
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Provider Practice Location Address
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Address Line | 851 WERNER CT STE 100
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City | CASPER
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State | WY
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Zip | 82601-1308
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Country | US
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Telephone | 307-234-9360
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Fax |
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Provider Business Mailing Address
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Address Line | 6661 BLUE SPRINGS RD
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City | CASPER
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State | WY
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Zip | 82604-3649
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Country | US
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Telephone | 307-299-0499
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Fax |
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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-1289
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License Number State | WY
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